KETTI RAE BOLLER DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****12

License Status

ACTIVE

Business

Title

DDS

First Name

KETTI

Middle

RAE

Last Name

BOLLER

Business Name

KETTI RAE BOLLER DDS

Original Issue Date

06/08/2012

Effective Date

09/11/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60613

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

12/11/2024