THEODORE L QUILITZ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****40

License Status

NOT RENEWED

Business

First Name

THEODORE L

Last Name

QUILITZ

Suffix

DDS

Business Name

THEODORE L QUILITZ DDS

Original Issue Date

01/01/1998

Effective Date

06/11/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012