DIRK MICHAEL DONOVAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

NOT RENEWED

Business

First Name

DIRK

Middle

MICHAEL

Last Name

DONOVAN

Business Name

DIRK MICHAEL DONOVAN

Original Issue Date

11/18/2004

Effective Date

11/18/2004

Expiration Date

09/30/2006

City

OAK LAWN

State

Zip

60453

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006