MARK WILLIAM JACOB Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****40

License Status

ACTIVE

Business

First Name

MARK WILLIAM

Last Name

JACOB

Business Name

MARK WILLIAM JACOB

Original Issue Date

09/21/1984

Effective Date

06/12/2024

Expiration Date

09/30/2027

City

NORTHBROOK

State

Zip

60062

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/12/2024