ERIC MATTHEW BASTA DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****01

License Status

ACTIVE

Business

Title

DDS

First Name

ERIC

Middle

MATTHEW

Last Name

BASTA

Business Name

ERIC MATTHEW BASTA DDS

Original Issue Date

03/29/2018

Effective Date

05/10/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60607

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/10/2024