AMY ADEL BASTAWROS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****51

License Status

ACTIVE

Business

First Name

AMY

Middle

ADEL

Last Name

BASTAWROS

Business Name

AMY ADEL BASTAWROS

Original Issue Date

12/18/2017

Effective Date

06/26/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/26/2024