NICK FREDERICKA 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

NICK

Last Name

FREDERICKA

Business Name

NICK FREDERICKA

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005