ANDREW GEORGE MORTENSEN Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****71

License Status

CANCELLED

Business

First Name

ANDREW GEORGE

Last Name

MORTENSEN

Business Name

ANDREW GEORGE MORTENSEN

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

EVANSTON

State

Zip

60202

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005