SAM B BASSALI DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

ACTIVE

Business

First Name

SAM B

Last Name

BASSALI

Suffix

DDS

Business Name

SAM B BASSALI DDS

Original Issue Date

08/31/1993

Effective Date

06/14/2024

Expiration Date

09/30/2027

City

MOUNT PROSPECT

State

Zip

60056

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/14/2024