HAROLD A BLACK DDS Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****40

License Status

INOPERATIVE

Business

First Name

HAROLD A

Last Name

BLACK

Suffix

DDS

Business Name

HAROLD A BLACK DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2000

City

CHICAGO

State

Zip

60649

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005