GIANCARLO A MALDONADO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****01

License Status

NOT RENEWED

Business

First Name

GIANCARLO

Middle

Last Name

MALDONADO

Suffix

DDS

Business Name

GIANCARLO A MALDONADO DDS

Original Issue Date

12/15/2004

Effective Date

12/15/2004

Expiration Date

09/30/2006

City

CHICAGO

State

Zip

60623

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006