SUSAN VANDERBERG DENT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

First Name

SUSAN VANDERBERG

Last Name

DENT

Suffix

Business Name

SUSAN VANDERBERG DENT MD

Original Issue Date

01/01/1997

Effective Date

06/12/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017