MITALKUMAR KALIDAS PATEL Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

ACTIVE

Business

First Name

MITALKUMAR

Middle

KALIDAS

Last Name

PATEL

Business Name

MITALKUMAR KALIDAS PATEL

Original Issue Date

06/02/2010

Effective Date

05/01/2024

Expiration Date

09/30/2027

City

MACHESNEY PARK

State

Zip

61115

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2024