EGILL LARS JACOBSEN 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

EGILL

Middle

LARS

Last Name

JACOBSEN

Business Name

EGILL LARS JACOBSEN

Original Issue Date

02/17/1983

Effective Date

08/10/2015

Expiration Date

09/30/2018

City

ELMHURST

State

Zip

60126

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018