CARRIE A CHAN Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

CANCELLED

Business

First Name

CARRIE A

Last Name

CHAN

Business Name

CARRIE A CHAN

Original Issue Date

01/04/1991

Effective Date

01/04/1991

Expiration Date

09/30/1992

City

LAGRANGE PARK

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005