MARY DIYA CHALAVEETIL Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

ACTIVE

Business

First Name

MARY DIYA

Last Name

CHALAVEETIL

Business Name

MARY DIYA CHALAVEETIL

Original Issue Date

08/25/2023

Effective Date

06/15/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/15/2024