BRUCE B COSTAGLI Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

INOPERATIVE

Business

First Name

BRUCE

Middle

Last Name

COSTAGLI

Business Name

BRUCE B COSTAGLI

Original Issue Date

10/10/1983

Effective Date

07/06/2015

Expiration Date

09/30/2018

City

SCHAUMBURG

State

Zip

60194

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2018