CHRISTIAN MERIT FORTNEY-CICCARELLA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001094

License Status

NOT RENEWED

Business

First Name

CHRISTIAN

Middle

MERIT

Last Name

FORTNEY-CICCARELLA

Suffix

DDS

Business Name

CHRISTIAN MERIT FORTNEY-CICCARELLA DDS

Original Issue Date

06/15/1998

Effective Date

06/15/1998

Expiration Date

06/30/1999

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005