MICHAEL RONALD MAZUKELLI Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001221

License Status

NOT RENEWED

Business

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

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005