JACK CAPODICE JR Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****26

License Status

ACTIVE

Business

First Name

JACK

Last Name

CAPODICE JR

Business Name

JACK CAPODICE JR

Original Issue Date

01/17/1992

Effective Date

08/02/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/02/2024