SHELLY GUPTA PENUMALLI DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019026749

License Status

NOT RENEWED

Business

First Name

SHELLY

Middle

GUPTA

Last Name

PENUMALLI

Suffix

DMD

Business Name

SHELLY GUPTA PENUMALLI DMD

Original Issue Date

05/31/2005

Effective Date

10/01/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60622

County

COOK

Ever Disciplined

LastModifiedDate

01/08/2010