DONALD JOSEPH PROVENZALE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****45

License Status

NOT RENEWED

Business

First Name

DONALD JOSEPH

Last Name

PROVENZALE

Suffix

DDS

Business Name

DONALD JOSEPH PROVENZALE DDS

Original Issue Date

01/01/1998

Effective Date

01/26/2022

Expiration Date

09/30/2024

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025