MARYAM GHEISARIFAR Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

ACTIVE

Business

First Name

MARYAM

Last Name

GHEISARIFAR

Business Name

MARYAM GHEISARIFAR

Original Issue Date

12/31/2022

Effective Date

07/09/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60654

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/09/2024