JAMIE Y PARK DDS 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

JAMIE

Middle

Last Name

PARK

Suffix

DDS

Business Name

JAMIE Y PARK DDS

Original Issue Date

06/15/2004

Effective Date

06/15/2004

Expiration Date

09/30/2006

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006