MARVIN KOZLOV 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

MARVIN

Last Name

KOZLOV

Business Name

MARVIN KOZLOV

Original Issue Date

01/01/1998

Effective Date

09/28/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/14/2012