MARCIO ANTONIO DA FONSECA DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000191

License Status

INACTIVE

Business

Title

DDS

First Name

MARCIO

Middle

ANTONIO

Last Name

DA FONSECA

Business Name

MARCIO ANTONIO DA FONSECA DDS

Original Issue Date

08/12/2013

Effective Date

05/02/2024

Expiration Date

09/30/2026

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

05/20/2025