MICHAEL P SHAW Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

NOT RENEWED

Business

First Name

MICHAEL P

Last Name

SHAW

Business Name

MICHAEL P SHAW

Original Issue Date

09/15/1987

Effective Date

09/15/1987

Expiration Date

09/30/1988

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005