PATRICIA A TARALLO DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

NOT RENEWED

Business

First Name

PATRICIA A

Last Name

TARALLO

Suffix

DMD

Business Name

PATRICIA A TARALLO DMD

Original Issue Date

03/01/1993

Effective Date

09/29/2009

Expiration Date

09/30/2012

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012