LIDIANE FUMIKO TAKEDA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

ACTIVE

Business

First Name

LIDIANE

Middle

FUMIKO

Last Name

TAKEDA

Business Name

LIDIANE FUMIKO TAKEDA

Original Issue Date

08/11/2023

Effective Date

08/14/2024

Expiration Date

09/30/2027

City

ORLAND HILLS

State

Zip

60487

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/14/2024