MICHAEL RONALD MAZUKELLI - Dentist License in Illinois | # 018001221

MICHAEL RONALD MAZUKELLI

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001221

License Status

NOT RENEWED

Business

N

First Name

MICHAEL

Middle

RONALD

Last Name

MAZUKELLI

Business Name

MICHAEL RONALD MAZUKELLI

Original Issue Date

06/20/2000

Effective Date

06/20/2000

Expiration Date

06/30/2001

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005