SAGE JACKLYN VANANTWERP DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****48

License Status

ACTIVE

Business

First Name

SAGE

Middle

JACKLYN

Last Name

VANANTWERP

Suffix

DMD

Business Name

SAGE JACKLYN VANANTWERP DMD

Original Issue Date

09/18/2018

Effective Date

09/15/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60655

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/15/2024