PAUL ETHAN WINE 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

PAUL

Middle

ETHAN

Last Name

WINE

Suffix

DDS

Business Name

PAUL ETHAN WINE DDS

Original Issue Date

07/15/2003

Effective Date

06/04/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60622

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012