SHANTHI NALLASAMY DMD 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

SHANTHI

Last Name

NALLASAMY

Suffix

DMD

Business Name

SHANTHI NALLASAMY DMD

Original Issue Date

10/17/2007

Effective Date

10/17/2007

Expiration Date

09/30/2009

City

WEST DUNDEE

State

Zip

60118

County

KANE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009