KEERTHI GOLLA DMD Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001337

License Status

EXPIRED

Business

First Name

KEERTHI

Last Name

GOLLA

Suffix

DMD

Business Name

KEERTHI GOLLA DMD

Original Issue Date

06/05/2002

Effective Date

06/05/2002

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005