PAUL ANTHONY NISSEN DDS 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

PAUL ANTHONY

Last Name

NISSEN

Suffix

DDS

Business Name

PAUL ANTHONY NISSEN DDS

Original Issue Date

01/20/1998

Effective Date

07/19/2015

Expiration Date

09/30/2018

City

HIGHLAND PARK

State

Zip

60035

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018