NIRA SHASHIKANT PATEL Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

NOT RENEWED

Business

First Name

NIRA

Middle

SHASHIKANT

Last Name

PATEL

Business Name

NIRA SHASHIKANT PATEL

Original Issue Date

12/18/2012

Effective Date

07/24/2015

Expiration Date

09/30/2018

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018