MICHELLE DISTEFANO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****33

License Status

NOT RENEWED

Business

First Name

MICHELLE

Last Name

DISTEFANO

Business Name

MICHELLE DISTEFANO

Original Issue Date

07/20/2012

Effective Date

09/30/2021

Expiration Date

09/30/2024

City

LINDENHURST

State

Zip

60046

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025