MATT ADAM MLSNA 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

MATT ADAM

Last Name

MLSNA

Business Name

MATT ADAM MLSNA

Original Issue Date

06/05/1986

Effective Date

06/05/1986

Expiration Date

09/30/1986

City

AURORA

State

Zip

60505

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005