DALE KONRAD KOSTIWA - Dentist License in Illinois | # 021000487

DALE KONRAD KOSTIWA

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021000487

License Status

INACTIVE

Business

N

First Name

DALE KONRAD

Last Name

KOSTIWA

Business Name

DALE KONRAD KOSTIWA

Original Issue Date

11/23/1965

Effective Date

11/23/1965

Expiration Date

09/30/2002

State

IL

Specialty/Qualifier

Orthodontics

Ever Disciplined

N

LastModifiedDate

10/17/2005