PAYAL D SHROFF Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

NOT RENEWED

Business

First Name

PAYAL

Middle

Last Name

SHROFF

Business Name

PAYAL D SHROFF

Original Issue Date

09/27/2006

Effective Date

09/27/2006

Expiration Date

09/30/2009

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

III

Ever Disciplined

LastModifiedDate

11/04/2009