DALE KONRAD KOSTIWA Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

CANCELLED

Business

First Name

DALE KONRAD

Last Name

KOSTIWA

Business Name

DALE KONRAD KOSTIWA

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

ST CHARLES

State

Zip

60174

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005