PHILLIP K MALLOW Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****85

License Status

ACTIVE

Business

First Name

PHILLIP K

Last Name

MALLOW

Business Name

PHILLIP K MALLOW

Original Issue Date

09/20/2006

Effective Date

08/06/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/06/2024