TENY MATAVOOSI Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****51

License Status

NOT RENEWED

Business

First Name

TENY

Last Name

MATAVOOSI

Business Name

TENY MATAVOOSI

Original Issue Date

06/27/2019

Effective Date

06/27/2019

Expiration Date

01/31/2022

City

OAK PARK

State

Zip

60302

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022