BLAINE PATRICK CUSACK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****60

License Status

NOT RENEWED

Business

First Name

BLAINE

Middle

PATRICK

Last Name

CUSACK

Business Name

BLAINE PATRICK CUSACK

Original Issue Date

09/24/1984

Effective Date

11/10/2021

Expiration Date

09/30/2024

City

COUNTRYSIDE

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025