MARK B JACOB DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

NOT RENEWED

Business

Title

DDS

First Name

MARK

Middle

Last Name

JACOB

Business Name

MARK B JACOB DDS

Original Issue Date

08/28/2002

Effective Date

08/24/2015

Expiration Date

09/30/2018

City

SKOKIE

State

Zip

60077

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018