JEFFREY DAVID GLEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

First Name

JEFFREY DAVID

Last Name

GLEN

Business Name

JEFFREY DAVID GLEN

Original Issue Date

10/19/1984

Effective Date

10/19/1984

Expiration Date

09/30/1988

City

CHICAGO

State

Zip

60624

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005