GINA MIRA JACOBSEN DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****56

License Status

ACTIVE

Business

First Name

GINA

Middle

MIRA

Last Name

JACOBSEN

Suffix

DDS

Business Name

GINA MIRA JACOBSEN DDS

Original Issue Date

05/29/2007

Effective Date

07/03/2024

Expiration Date

09/30/2027

City

OSWEGO

State

Zip

60543

County

KENDALL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/03/2024