PAYAM MATIN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****43

License Status

NOT RENEWED

Business

Title

DMD

First Name

PAYAM

Last Name

MATIN

Business Name

PAYAM MATIN DMD

Original Issue Date

08/01/2011

Effective Date

08/28/2012

Expiration Date

09/30/2015

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016