JEFFREY HOWARD KOOTMAN 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

JEFFREY HOWARD

Last Name

KOOTMAN

Business Name

JEFFREY HOWARD KOOTMAN

Original Issue Date

12/16/1983

Effective Date

12/16/1983

Expiration Date

09/30/1988

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005