GREGORY GRANT OLSEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

NOT RENEWED

Business

First Name

GREGORY

Middle

GRANT

Last Name

OLSEN

Business Name

GREGORY GRANT OLSEN

Original Issue Date

10/01/2007

Effective Date

09/08/2009

Expiration Date

09/30/2012

City

CICERO

State

Zip

60804

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012