LISA J SKROCKI IDNANI DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

CANCELLED

Business

First Name

LISA

Middle

J SKROCKI

Last Name

IDNANI

Suffix

DDS

Business Name

LISA J SKROCKI IDNANI DDS

Original Issue Date

09/05/2003

Effective Date

09/05/2003

Expiration Date

09/30/2006

City

CHICAGO

State

Zip

60618

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006