BASSAM ALI ISSA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****74

License Status

NOT RENEWED

Business

First Name

BASSAM

Middle

ALI

Last Name

ISSA

Business Name

BASSAM ALI ISSA

Original Issue Date

07/31/2012

Effective Date

07/31/2012

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60643

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016