SCOTT LEWIS DALTON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****95

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

LEWIS

Last Name

DALTON

Business Name

SCOTT LEWIS DALTON

Original Issue Date

03/25/2002

Effective Date

03/25/2002

Expiration Date

09/30/2004

City

CHICAGO

State

Zip

60634

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005