TERRANCE LORNE JACKSON DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

ACTIVE

Business

Title

DMD

First Name

TERRANCE

Middle

LORNE

Last Name

JACKSON

Business Name

TERRANCE LORNE JACKSON DMD

Original Issue Date

03/11/2022

Effective Date

07/03/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60654

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/03/2024