LACEY MONTIREY GREEN 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

LACEY

Middle

MONTIREY

Last Name

GREEN

Suffix

DDS

Business Name

LACEY MONTIREY GREEN DDS

Original Issue Date

12/20/2010

Effective Date

12/20/2010

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60619

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012