THEODORE MICHAEL SIEGEL Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****67

License Status

ACTIVE

Business

First Name

THEODORE MICHAEL

Last Name

SIEGEL

Business Name

THEODORE MICHAEL SIEGEL

Original Issue Date

09/05/1984

Effective Date

08/13/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60618

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/13/2024