STACI L BLAZENIAK Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020015217

License Status

ACTIVE

Business

First Name

STACI

Middle

Last Name

BLAZENIAK

Business Name

STACI L BLAZENIAK

Original Issue Date

08/04/2015

Effective Date

09/05/2024

Expiration Date

09/30/2027

City

OAK FOREST

State

Zip

60452

County

COOK

Ever Disciplined

LastModifiedDate

09/05/2024