CHAD R WIERSEMA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

First Name

CHAD

Middle

Last Name

WIERSEMA

Suffix

DDS

Business Name

CHAD R WIERSEMA DDS

Original Issue Date

05/06/2008

Effective Date

08/07/2009

Expiration Date

09/30/2012

City

OAK LAWN

State

Zip

60453

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012