FELICIA S MATA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****47

License Status

NOT RENEWED

Business

First Name

FELICIA S

Last Name

MATA

Suffix

DMD

Business Name

FELICIA S MATA DMD

Original Issue Date

11/04/1996

Effective Date

01/13/2017

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60602

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018