BASSAM ALI ISSA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

NOT RENEWED

Business

First Name

BASSAM

Middle

ALI

Last Name

ISSA

Business Name

BASSAM ALI ISSA

Original Issue Date

03/10/2016

Effective Date

09/11/2021

Expiration Date

09/30/2024

City

CALUMET CITY

State

Zip

60409

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025