MANUEL A BUSTAMANTE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

First Name

MANUEL A

Last Name

BUSTAMANTE

Business Name

MANUEL A BUSTAMANTE

Original Issue Date

05/03/1988

Effective Date

05/03/1988

Expiration Date

09/30/1990

City

OAKBROOK TERRACE

State

Zip

60181

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005