AMITA P RAVAL Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

NOT RENEWED

Business

First Name

AMITA P

Last Name

RAVAL

Business Name

AMITA P RAVAL

Original Issue Date

05/11/1998

Effective Date

06/13/2018

Expiration Date

01/31/2022

City

MONTGOMERY

State

Zip

60538

County

KENDALL

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/09/2022