LISA D GIFFORD 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

LISA

Middle

Last Name

GIFFORD

Business Name

LISA D GIFFORD

Original Issue Date

01/24/2000

Effective Date

01/24/2000

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60602

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005