PAUL MICHAEL BROADWATER 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

PAUL MICHAEL

Last Name

BROADWATER

Business Name

PAUL MICHAEL BROADWATER

Original Issue Date

08/31/1984

Effective Date

08/31/1984

Expiration Date

09/30/1986

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005