T COOPER COLQUITT Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****98

License Status

NOT RENEWED

Business

First Name

T COOPER

Last Name

COLQUITT

Business Name

T COOPER COLQUITT

Original Issue Date

08/23/1996

Effective Date

08/23/1996

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60619

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005