SHELLY GUPTA PENUMALLI DMD - Dentist License in Illinois | # 019026749

SHELLY GUPTA PENUMALLI DMD

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019026749

License Status

NOT RENEWED

Business

N

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

State

IL

Ever Disciplined

N

LastModifiedDate

01/08/2010