DARRYL JAY PENA BANEZ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

NOT RENEWED

Business

Title

DDS

First Name

DARRYL JAY

Middle

PENA

Last Name

BANEZ

Business Name

DARRYL JAY PENA BANEZ DDS

Original Issue Date

06/05/2017

Effective Date

09/12/2018

Expiration Date

01/31/2022

City

ZION

State

Zip

60099

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022