MATIN MIKAYIL IMANGULI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****36

License Status

NOT RENEWED

Business

First Name

MATIN

Middle

MIKAYIL

Last Name

IMANGULI

Suffix

DDS

Business Name

MATIN MIKAYIL IMANGULI DDS

Original Issue Date

12/12/2008

Effective Date

12/12/2008

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60621

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009