THAER ALI DAIFALLAH 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

Title

DDS

First Name

THAER

Middle

ALI

Last Name

DAIFALLAH

Business Name

THAER ALI DAIFALLAH DDS

Original Issue Date

10/02/2014

Effective Date

10/02/2014

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60638

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016