DAVID A GLASS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

Last Name

GLASS

Business Name

DAVID A GLASS

Original Issue Date

04/17/1998

Effective Date

04/17/1998

Expiration Date

09/30/1998

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005