DONALD JOSEPH PROVENZALE DDS - Dentist License in Illinois | # 019012314

DONALD JOSEPH PROVENZALE DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019012314

License Status

NOT RENEWED

Business

N

First Name

DONALD JOSEPH

Last Name

PROVENZALE

Suffix

DDS

Business Name

DONALD JOSEPH PROVENZALE DDS

Original Issue Date

07/31/1963

Effective Date

01/19/2022

Expiration Date

09/30/2024

State

IL

Ever Disciplined

N

LastModifiedDate

02/04/2025