TINA MICHELL CHAMPION-HARRIS 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

TINA

Middle

MICHELL

Last Name

CHAMPION-HARRIS

Business Name

TINA MICHELL CHAMPION-HARRIS

Original Issue Date

02/11/2002

Effective Date

09/21/2015

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60615

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018