HEATHER A MALLORY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

HEATHER A

Last Name

MALLORY

Business Name

HEATHER A MALLORY

Original Issue Date

10/07/1988

Effective Date

10/07/1988

Expiration Date

09/30/1990

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005