RONNIE A ATA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

ACTIVE

Business

First Name

RONNIE

Middle

Last Name

ATA

Business Name

RONNIE A ATA

Original Issue Date

08/25/2018

Effective Date

05/04/2024

Expiration Date

09/30/2027

City

LEMONT

State

Zip

60439

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2024