PRATHIP SIVAPRAKASAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

Business

First Name

PRATHIP

Last Name

SIVAPRAKASAM

Business Name

PRATHIP SIVAPRAKASAM

Original Issue Date

02/17/2010

Effective Date

02/17/2010

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60661

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012