M CAMILLE FULLER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****94

License Status

NOT RENEWED

Business

First Name

Middle

CAMILLE

Last Name

FULLER

Suffix

DDS

Business Name

M CAMILLE FULLER DDS

Original Issue Date

07/11/1991

Effective Date

07/11/1991

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60603

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005