SHAFAQ R MUSTAFA 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

SHAFAQ

Middle

Last Name

MUSTAFA

Suffix

DDS

Business Name

SHAFAQ R MUSTAFA DDS

Original Issue Date

10/21/2004

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

SOUTH HOLLAND

State

Zip

60473

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/31/2014