DONALD J PROVENZALE JR DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000289

License Status

ACTIVE

Business

First Name

DONALD

Middle

Last Name

PROVENZALE

Suffix

JR DDS

Business Name

DONALD J PROVENZALE JR DDS

Original Issue Date

04/02/1991

Effective Date

07/26/2024

Expiration Date

09/30/2027

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

07/26/2024