ERIC NILS BLOOM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****68

License Status

NOT RENEWED

Business

First Name

ERIC NILS

Last Name

BLOOM

Suffix

DDS

Business Name

ERIC NILS BLOOM DDS

Original Issue Date

01/05/1998

Effective Date

01/05/1998

Expiration Date

09/30/2002

City

EVANSTON

State

Zip

60201

County

COOK

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/17/2005