DOMINIK A ETTLIN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****91

License Status

NOT RENEWED

Business

First Name

DOMINIK A

Last Name

ETTLIN

Suffix

DMD

Business Name

DOMINIK A ETTLIN DMD

Original Issue Date

12/06/1996

Effective Date

12/06/1996

Expiration Date

09/30/2000

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005