TANATCHA KUKIRATIRAT Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****52

License Status

ACTIVE

Business

First Name

TANATCHA

Last Name

KUKIRATIRAT

Business Name

TANATCHA KUKIRATIRAT

Original Issue Date

08/24/2021

Effective Date

09/06/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60659

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/06/2024