DALE BENJAMIN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****47

License Status

NOT RENEWED

Business

First Name

DALE

Last Name

BENJAMIN DMD

Business Name

DALE BENJAMIN DMD

Original Issue Date

12/01/2011

Effective Date

12/01/2011

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012