EDWARD L MODESTO DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

CANCELLED

Business

First Name

EDWARD L

Last Name

MODESTO

Suffix

DDS

Business Name

EDWARD L MODESTO DDS

Original Issue Date

01/31/2005

Effective Date

01/31/2005

Expiration Date

09/30/2006

City

OAK BROOK

State

Zip

60523

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006