COREY DANE KONIECZKI DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

ACTIVE

Business

Title

DMD

First Name

COREY

Middle

DANE

Last Name

KONIECZKI

Business Name

COREY DANE KONIECZKI DMD

Original Issue Date

06/02/2021

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024