SHANE GALEN SUDMAN 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

SHANE

Middle

GALEN

Last Name

SUDMAN

Suffix

DDS

Business Name

SHANE GALEN SUDMAN DDS

Original Issue Date

01/19/1999

Effective Date

06/11/2015

Expiration Date

09/30/2018

City

NEW LENOX

State

Zip

60451

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018