KELLIE LYNN MOORE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****80

License Status

NOT RENEWED

Business

First Name

KELLIE

Middle

LYNN

Last Name

MOORE

Business Name

KELLIE LYNN MOORE

Original Issue Date

04/24/2019

Effective Date

09/11/2021

Expiration Date

09/30/2024

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025