MICHAEL RONALD MAZUKELLI Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****44

License Status

ACTIVE

Business

First Name

MICHAEL

Middle

RONALD

Last Name

MAZUKELLI

Business Name

MICHAEL RONALD MAZUKELLI

Original Issue Date

04/06/2001

Effective Date

09/25/2024

Expiration Date

09/30/2027

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/25/2024