JACOB GEORGE GROSELAK Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

License Status

ACTIVE

Business

First Name

JACOB

Middle

GEORGE

Last Name

GROSELAK

Business Name

JACOB GEORGE GROSELAK

Original Issue Date

06/01/2019

Effective Date

08/14/2024

Expiration Date

09/30/2027

City

DARIEN

State

Zip

60561

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/14/2024