SAMANTHA LYNN HOLDER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****80

License Status

NOT RENEWED

Business

Title

DDS

First Name

SAMANTHA

Middle

LYNN

Last Name

HOLDER

Business Name

SAMANTHA LYNN HOLDER DDS

Original Issue Date

01/30/2007

Effective Date

01/30/2007

Expiration Date

09/30/2009

City

NEW LENOX

State

Zip

60451

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009