BERNADETTE A FA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

NOT RENEWED

Business

First Name

BERNADETTE

Middle

Last Name

Business Name

BERNADETTE A FA

Original Issue Date

12/23/2009

Effective Date

12/23/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012