SCOTT MATHEW PETERSON 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

SCOTT

Middle

MATHEW

Last Name

PETERSON

Business Name

SCOTT MATHEW PETERSON

Original Issue Date

09/04/2001

Effective Date

09/04/2001

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005