DAVID JEFFREY BLACKMAN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****67

License Status

NOT RENEWED

Business

Title

DDS

First Name

DAVID

Middle

JEFFREY

Last Name

BLACKMAN

Business Name

DAVID JEFFREY BLACKMAN DDS

Original Issue Date

07/31/1981

Effective Date

07/31/1981

Expiration Date

06/01/1982

City

CHICAGO

State

Zip

60624

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005