EVERT C TAN 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

EVERT

Middle

Last Name

TAN

Business Name

EVERT C TAN

Original Issue Date

09/12/2011

Effective Date

09/12/2011

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60626

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012