MARK LEON TANNENBAUM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****70

License Status

NOT RENEWED

Business

First Name

MARK LEON

Last Name

TANNENBAUM

Suffix

DDS

Business Name

MARK LEON TANNENBAUM DDS

Original Issue Date

01/20/2012

Effective Date

08/26/2015

Expiration Date

09/30/2018

City

BURBANK

State

Zip

60459

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/31/2018