SHOUVIK PONNUSAMY DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****19

License Status

NOT RENEWED

Business

Title

DMD

First Name

SHOUVIK

Last Name

PONNUSAMY

Business Name

SHOUVIK PONNUSAMY DMD

Original Issue Date

06/03/2020

Effective Date

06/03/2020

Expiration Date

01/31/2022

City

GURNEE

State

Zip

60031

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022