BANDANA BISTA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

NOT RENEWED

Business

First Name

BANDANA

Last Name

BISTA

Suffix

DDS

Business Name

BANDANA BISTA DDS

Original Issue Date

07/26/2011

Effective Date

09/05/2012

Expiration Date

09/30/2015

City

OAK BROOK

State

Zip

60523

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016