MITRA A DERAKHSHAN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****41

License Status

NOT RENEWED

Business

First Name

MITRA

Middle

Last Name

DERAKHSHAN

Suffix

DMD

Business Name

MITRA A DERAKHSHAN DMD

Original Issue Date

05/08/2008

Effective Date

05/08/2008

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60605

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009