JAIME M POULOS DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

First Name

JAIME

Middle

Last Name

POULOS

Suffix

DDS

Business Name

JAIME M POULOS DDS

Original Issue Date

06/13/2008

Effective Date

06/13/2008

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60647

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009