FRED A MATSUMOTO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****44

License Status

NOT RENEWED

Business

First Name

FRED A

Last Name

MATSUMOTO

Suffix

DDS

Business Name

FRED A MATSUMOTO DDS

Original Issue Date

08/30/1991

Effective Date

08/30/1991

Expiration Date

09/30/2000

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/17/2005