JAY HOWARD BLACKBURN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

JAY HOWARD

Last Name

BLACKBURN

Suffix

DDS

Business Name

JAY HOWARD BLACKBURN DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1992

City

CALUMET CITY

State

Zip

60409

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005