BHOOMI DEVEN KOTAK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

NOT RENEWED

Business

First Name

BHOOMI

Middle

DEVEN

Last Name

KOTAK

Business Name

BHOOMI DEVEN KOTAK

Original Issue Date

09/25/2017

Effective Date

09/25/2017

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60609

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018