LISA ANN FORTUNATO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

NOT RENEWED

Business

Title

DDS

First Name

LISA

Middle

ANN

Last Name

FORTUNATO

Business Name

LISA ANN FORTUNATO DDS

Original Issue Date

02/09/2010

Effective Date

07/20/2012

Expiration Date

09/30/2015

City

VERO BEACH

State

Zip

32960

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016