MARK MATTHEW WIDLOSKI 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

MARK MATTHEW

Last Name

WIDLOSKI

Business Name

MARK MATTHEW WIDLOSKI

Original Issue Date

07/20/1982

Effective Date

07/20/1982

Expiration Date

09/30/1984

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005