CARRIE A CHAN 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

CARRIE A

Last Name

CHAN

Business Name

CARRIE A CHAN

Original Issue Date

04/18/1988

Effective Date

06/09/2009

Expiration Date

09/30/2012

City

DARIEN

State

Zip

60561

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012