SAMEH EMAD AZAB DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

INACTIVE

Business

Title

DDS

First Name

SAMEH

Middle

EMAD

Last Name

AZAB

Business Name

SAMEH EMAD AZAB DDS

Original Issue Date

06/23/2011

Effective Date

07/30/2018

Expiration Date

12/31/2021

City

RACINE

State

Zip

53406

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/28/2021