EDWIN WESLEY MANGRAM II DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****63

License Status

ACTIVE

Business

First Name

EDWIN

Middle

WESLEY

Last Name

MANGRAM II

Suffix

DDS

Business Name

EDWIN WESLEY MANGRAM II DDS

Original Issue Date

11/21/2000

Effective Date

09/02/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60623

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/02/2024