JACOB D SURJAN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****44

License Status

INACTIVE

Business

First Name

JACOB

Middle

Last Name

SURJAN

Suffix

DDS

Business Name

JACOB D SURJAN DDS

Original Issue Date

11/20/2006

Effective Date

08/15/2018

Expiration Date

12/31/2021

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/22/2021