BENJAMIN ANTHONY LOGIUDICE Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****65

License Status

CANCELLED

Business

First Name

BENJAMIN

Middle

ANTHONY

Last Name

LOGIUDICE

Business Name

BENJAMIN ANTHONY LOGIUDICE

Original Issue Date

02/20/2002

Effective Date

02/20/2002

Expiration Date

09/30/2002

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005