DEREK H FORNELLI DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

ACTIVE

Business

First Name

DEREK

Middle

Last Name

FORNELLI DDS

Business Name

DEREK H FORNELLI DDS

Original Issue Date

06/03/2022

Effective Date

09/30/2024

Expiration Date

09/30/2027

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/30/2024