YELENA M REVICH 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

YELENA

Middle

Last Name

REVICH

Suffix

DDS

Business Name

YELENA M REVICH DDS

Original Issue Date

08/17/2004

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60634

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009