TIMOTHY JOHN KICZENSKI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****06

License Status

NOT RENEWED

Business

Title

DDS

First Name

TIMOTHY

Middle

JOHN

Last Name

KICZENSKI

Business Name

TIMOTHY JOHN KICZENSKI DDS

Original Issue Date

01/01/1998

Effective Date

10/02/2012

Expiration Date

09/30/2015

City

BENSENVILLE

State

Zip

60106

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016