LYNETTE C FORTENBERRY DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****68

License Status

CANCELLED

Business

First Name

LYNETTE

Middle

Last Name

FORTENBERRY

Suffix

DMD

Business Name

LYNETTE C FORTENBERRY DMD

Original Issue Date

06/15/1999

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/31/2009