EDGAR DEMAREST GIFFORD Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****83

License Status

INOPERATIVE

Business

First Name

EDGAR DEMAREST

Last Name

GIFFORD

Business Name

EDGAR DEMAREST GIFFORD

Original Issue Date

03/07/1994

Effective Date

03/07/1994

Expiration Date

09/30/2000

City

LAGRANGE

State

Zip

60525

County

COOK

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/17/2005