CHRISTIAN MERIT FORTNEY-CICCARELLA DDS - Dentist License in Illinois | # 018001094

CHRISTIAN MERIT FORTNEY-CICCARELLA DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001094

License Status

NOT RENEWED

Business

N

First Name

CHRISTIAN

Middle

MERIT

Last Name

FORTNEY-CICCARELLA

Suffix

DDS

Business Name

CHRISTIAN MERIT FORTNEY-CICCARELLA DDS

Original Issue Date

06/15/1998

Effective Date

06/15/1998

Expiration Date

06/30/1999

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005