ROBERT J BERQUIST 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

ROBERT J

Last Name

BERQUIST

Business Name

ROBERT J BERQUIST

Original Issue Date

08/18/1989

Effective Date

09/10/2009

Expiration Date

09/30/2012

City

FLOSSMOOR

State

Zip

60422

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012