DIANA MANDEL TATCH Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****62

License Status

CANCELLED

Business

First Name

DIANA

Last Name

MANDEL TATCH

Business Name

DIANA MANDEL TATCH

Original Issue Date

07/03/2002

Effective Date

07/03/2002

Expiration Date

09/30/2004

City

SCHAUMBURG

State

Zip

60193

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005