JACK L LARSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****66

License Status

NOT RENEWED

Business

First Name

JACK L

Last Name

LARSON

Business Name

JACK L LARSON

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60617

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005