SHAFA AMIRSOLTANI Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

CANCELLED

Business

First Name

SHAFA

Last Name

AMIRSOLTANI

Business Name

SHAFA AMIRSOLTANI

Original Issue Date

02/16/2017

Effective Date

08/29/2018

Expiration Date

09/30/2021

City

ELMWOOD PARK

State

Zip

60707

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/29/2018