SIRI CHANTHASALO DDS 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

SIRI

Last Name

CHANTHASALO

Suffix

DDS

Business Name

SIRI CHANTHASALO DDS

Original Issue Date

07/12/2002

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CAROL STREAM

State

Zip

60188

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009