PRAVEEN KUMAR GONUGUNTLA KAMMA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****02

License Status

NOT RENEWED

Business

Title

DMD

First Name

PRAVEEN KUMAR

Last Name

GONUGUNTLA KAMMA

Business Name

PRAVEEN KUMAR GONUGUNTLA KAMMA DMD

Original Issue Date

08/21/2020

Effective Date

08/21/2020

Expiration Date

01/31/2022

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022