MARISSA E DZIEPAK Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137001026

License Status

ACTIVE

Business

First Name

MARISSA

Middle

Last Name

DZIEPAK

Business Name

MARISSA E DZIEPAK

Original Issue Date

06/19/2019

Effective Date

06/05/2024

Expiration Date

09/30/2027

City

BARTLETT

State

Zip

60103

County

DUPAGE

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

06/05/2024