KENNETH ROBERT MARRIOTT DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

NOT RENEWED

Business

Title

DDS

First Name

KENNETH

Middle

ROBERT

Last Name

MARRIOTT

Business Name

KENNETH ROBERT MARRIOTT DDS

Original Issue Date

06/16/2010

Effective Date

08/09/2012

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016