STEPHEN P RUSSO DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000623

License Status

ACTIVE

Business

Title

DMD

First Name

STEPHEN

Middle

Last Name

RUSSO

Business Name

STEPHEN P RUSSO DMD

Original Issue Date

08/03/2004

Effective Date

08/12/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60602

County

COOK

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

08/12/2024