KRISTIN M ELLIOT Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

NOT RENEWED

Business

First Name

KRISTIN

Middle

Last Name

ELLIOT

Business Name

KRISTIN M ELLIOT

Original Issue Date

08/05/2008

Effective Date

08/05/2008

Expiration Date

09/30/2009

City

LONG GROVE

State

Zip

60047

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009