TIMOTHY DAVID THEOBALD DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

ACTIVE

Business

Title

DMD

First Name

TIMOTHY

Middle

DAVID

Last Name

THEOBALD

Business Name

TIMOTHY DAVID THEOBALD DMD

Original Issue Date

08/06/2014

Effective Date

09/25/2024

Expiration Date

09/30/2027

City

GRAYSLAKE

State

Zip

60030

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/25/2024