TIMOTHY R FITZGERALD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****46

License Status

ACTIVE

Business

First Name

TIMOTHY R

Last Name

FITZGERALD

Business Name

TIMOTHY R FITZGERALD

Original Issue Date

08/10/1982

Effective Date

08/23/2024

Expiration Date

09/30/2027

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/23/2024