EDWARD L MODESTO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

NOT RENEWED

Business

First Name

EDWARD L

Last Name

MODESTO

Suffix

DDS

Business Name

EDWARD L MODESTO DDS

Original Issue Date

12/18/1991

Effective Date

08/13/2012

Expiration Date

09/30/2015

City

ORLAND PARK

State

Zip

60467

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016