LATANYA ALISA GALLON 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

LATANYA

Middle

ALISA

Last Name

GALLON

Business Name

LATANYA ALISA GALLON

Original Issue Date

07/12/2002

Effective Date

07/12/2002

Expiration Date

09/30/2004

City

LINDENHURST

State

Zip

60046

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005