THOMAS JACKSON 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

THOMAS

Last Name

JACKSON

Suffix

DDS

Business Name

THOMAS JACKSON DDS

Original Issue Date

01/14/2004

Effective Date

09/04/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012