ANJUM A ANSARI DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****90

License Status

NOT RENEWED

Business

First Name

ANJUM

Middle

Last Name

ANSARI

Suffix

DMD

Business Name

ANJUM A ANSARI DMD

Original Issue Date

02/23/1999

Effective Date

02/23/1999

Expiration Date

09/30/2004

City

SKOKIE

State

Zip

60077

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005