MITALI Y PATEL DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

CANCELLED

Business

First Name

MITALI

Middle

Last Name

PATEL

Suffix

DDS

Business Name

MITALI Y PATEL DDS

Original Issue Date

03/04/2010

Effective Date

03/04/2010

Expiration Date

09/30/2012

City

MUNDELEIN

State

Zip

60060

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/04/2010