VITO P LA SUSA DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001039

License Status

EXPIRED

Business

First Name

VITO

Middle

Last Name

LA SUSA

Suffix

DDS

Business Name

VITO P LA SUSA DDS

Original Issue Date

07/07/1997

Effective Date

07/07/1997

Expiration Date

06/30/2000

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Prosthodontics

Ever Disciplined

LastModifiedDate

10/12/2005