SHANE GALEN SUDMAN DDS 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

SHANE

Middle

GALEN

Last Name

SUDMAN

Suffix

DDS

Business Name

SHANE GALEN SUDMAN DDS

Original Issue Date

09/05/2006

Effective Date

09/05/2006

Expiration Date

09/30/2009

City

NEW LENOX

State

Zip

60451

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009