JASON W FREDRICK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****76

License Status

NOT RENEWED

Business

First Name

JASON W

Last Name

FREDRICK

Suffix

DDS

Business Name

JASON W FREDRICK DDS

Original Issue Date

12/12/1995

Effective Date

12/12/1995

Expiration Date

09/30/1996

City

ARLINGTON HEIGHTS

State

Zip

60005

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005