MARISSA E DZIEPAK - Dentist License in Illinois | # 137001026

MARISSA E DZIEPAK

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137001026

License Status

ACTIVE

Business

N

First Name

MARISSA

Middle

E

Last Name

DZIEPAK

Business Name

MARISSA E DZIEPAK

Original Issue Date

06/19/2019

Effective Date

06/05/2024

Expiration Date

09/30/2027

State

IL

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

N

LastModifiedDate

06/05/2024