JAYANTILAL THAKA MALLI DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****41

License Status

CANCELLED

Business

First Name

JAYANTILAL THAKA

Last Name

MALLI

Suffix

DDS

Business Name

JAYANTILAL THAKA MALLI DDS

Original Issue Date

04/15/1991

Effective Date

07/15/2015

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60647

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/15/2015