DARRYL A BIVENS DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****48

License Status

NOT RENEWED

Business

First Name

DARRYL A

Last Name

BIVENS

Suffix

DDS

Business Name

DARRYL A BIVENS DDS

Original Issue Date

02/14/1991

Effective Date

02/14/1991

Expiration Date

09/30/1992

City

CHICAGO

State

Zip

60617

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005