PRASANTH DOMMARAJU Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****42

License Status

ACTIVE

Business

First Name

PRASANTH

Last Name

DOMMARAJU

Business Name

PRASANTH DOMMARAJU

Original Issue Date

08/26/2019

Effective Date

10/01/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60632

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/01/2024