DONALD JOSEPH PROVENZALE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019012314

License Status

NOT RENEWED

Business

First Name

DONALD JOSEPH

Last Name

PROVENZALE

Suffix

DDS

Business Name

DONALD JOSEPH PROVENZALE DDS

Original Issue Date

07/31/1963

Effective Date

01/19/2022

Expiration Date

09/30/2024

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Ever Disciplined

LastModifiedDate

02/04/2025