THERESA M WESTFALLEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****42

License Status

NOT RENEWED

Business

First Name

THERESA

Middle

Last Name

WESTFALLEN

Business Name

THERESA M WESTFALLEN

Original Issue Date

12/10/2007

Effective Date

12/10/2007

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60630

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/04/2009