HASAN FAWWAZ OTHMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****38

License Status

NOT RENEWED

Business

First Name

HASAN

Middle

FAWWAZ

Last Name

OTHMAN

Business Name

HASAN FAWWAZ OTHMAN

Original Issue Date

01/31/2005

Effective Date

09/24/2018

Expiration Date

01/31/2022

City

LOMBARD

State

Zip

60148

County

DUPAGE

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/09/2022