KIAH A BALLANTINE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

NOT RENEWED

Business

First Name

KIAH

Middle

Last Name

BALLANTINE

Business Name

KIAH A BALLANTINE

Original Issue Date

02/14/2019

Effective Date

02/14/2019

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022