SHELLY GUPTA PENUMALLI DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

NOT RENEWED

Business

First Name

SHELLY

Middle

GUPTA

Last Name

PENUMALLI

Suffix

DMD

Business Name

SHELLY GUPTA PENUMALLI DMD

Original Issue Date

08/01/2005

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60622

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009