MARTHA HA DDS Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****70

License Status

INOPERATIVE

Business

Title

DDS

First Name

MARTHA

Last Name

Business Name

MARTHA HA DDS

Original Issue Date

07/18/2013

Effective Date

09/17/2015

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60610

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2018