JOSEPH MATTHEW FULLMER 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

JOSEPH

Middle

MATTHEW

Last Name

FULLMER

Business Name

JOSEPH MATTHEW FULLMER

Original Issue Date

08/17/2009

Effective Date

08/17/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012