THOMAS WILLIAM CARLSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****55

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

WILLIAM

Last Name

CARLSON

Business Name

THOMAS WILLIAM CARLSON

Original Issue Date

12/19/2002

Effective Date

06/16/2015

Expiration Date

09/30/2018

City

ANTIOCH

State

Zip

60002

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018