OMAR R CRUZ 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

OMAR

Middle

Last Name

CRUZ

Business Name

OMAR R CRUZ

Original Issue Date

07/20/2006

Effective Date

10/14/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012