SHADEE T MANSOUR Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

ACTIVE

Business

First Name

SHADEE

Middle

Last Name

MANSOUR

Business Name

SHADEE T MANSOUR

Original Issue Date

10/21/2020

Effective Date

05/14/2024

Expiration Date

09/30/2027

City

BARRINGTON

State

Zip

60010

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/14/2024