TATIANA M MITROVICH KOUKOUCHKINA DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

ACTIVE

Business

First Name

TATIANA

Middle

Last Name

MITROVICH KOUKOUCHKINA

Suffix

DDS

Business Name

TATIANA M MITROVICH KOUKOUCHKINA DDS

Original Issue Date

11/30/1998

Effective Date

08/25/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/25/2024