VITO P LA SUSA DDS - Dentist License in Illinois | # 018001039

VITO P LA SUSA DDS

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001039

License Status

EXPIRED

Business

N

First Name

VITO

Middle

P

Last Name

LA SUSA

Suffix

DDS

Business Name

VITO P LA SUSA DDS

Original Issue Date

07/07/1997

Effective Date

07/07/1997

Expiration Date

06/30/2000

State

IL

Specialty/Qualifier

Prosthodontics

Ever Disciplined

N

LastModifiedDate

10/12/2005