LARA A REGIS 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

LARA

Middle

Last Name

REGIS

Business Name

LARA A REGIS

Original Issue Date

09/18/2008

Effective Date

09/21/2009

Expiration Date

09/30/2012

City

CRYSTAL LAKE

State

Zip

60014

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012