MICHAEL C DEFAZIO Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019029664

License Status

ACTIVE

Business

First Name

MICHAEL

Middle

Last Name

DEFAZIO

Business Name

MICHAEL C DEFAZIO

Original Issue Date

10/03/2013

Effective Date

08/06/2024

Expiration Date

09/30/2027

City

SAN DIEGO

State

Zip

92103

Ever Disciplined

LastModifiedDate

08/06/2024