DONALD J PROVENZALE JR DDS - Dentist License in Illinois | # 019021170

DONALD J PROVENZALE JR DDS

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019021170

License Status

ACTIVE

Business

N

First Name

DONALD

Middle

J

Last Name

PROVENZALE

Suffix

JR DDS

Business Name

DONALD J PROVENZALE JR DDS

Original Issue Date

07/27/1988

Effective Date

07/26/2024

Expiration Date

09/30/2027

State

IL

Ever Disciplined

N

LastModifiedDate

08/26/2024