JAMES WILLIAM BLACKBURN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****99

License Status

NOT RENEWED

Business

First Name

JAMES

Middle

WILLIAM

Last Name

BLACKBURN

Suffix

DDS

Business Name

JAMES WILLIAM BLACKBURN DDS

Original Issue Date

04/04/2002

Effective Date

04/04/2002

Expiration Date

09/30/2004

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005