BLAKE EDWARD MOORES Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****92

License Status

NOT RENEWED

Business

First Name

BLAKE EDWARD

Last Name

MOORES

Business Name

BLAKE EDWARD MOORES

Original Issue Date

08/16/1983

Effective Date

08/16/1983

Expiration Date

09/30/1986

City

CHICAGO

State

Zip

60655

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005