SANDRA N JACKSON DENT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056101

License Status

CANCELLED

Business

Title

First Name

SANDRA

Middle

Last Name

JACKSON DENT

Business Name

SANDRA N JACKSON DENT MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

04/21/2009