JERRY LEE SODERSTROM 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

JERRY

Middle

LEE

Last Name

SODERSTROM

Suffix

DDS

Business Name

JERRY LEE SODERSTROM DDS

Original Issue Date

03/21/1984

Effective Date

03/21/1984

Expiration Date

09/30/1988

City

ANTIOCH

State

Zip

60002

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005