ROSS MICHAEL KOEPPEN DDS 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

ROSS

Middle

MICHAEL

Last Name

KOEPPEN

Suffix

DDS

Business Name

ROSS MICHAEL KOEPPEN DDS

Original Issue Date

06/06/2007

Effective Date

10/22/2009

Expiration Date

09/30/2012

City

BLUE ISLAND

State

Zip

60406

County

COOK

Specialty/Qualifier

PHARM DISTRIBUTOR

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/14/2012