JASON ROBERT JACOBY 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

JASON

Middle

ROBERT

Last Name

JACOBY

Business Name

JASON ROBERT JACOBY

Original Issue Date

07/17/2014

Effective Date

11/12/2015

Expiration Date

09/30/2018

City

PLAINFIELD

State

Zip

60585

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018