STEPHANIE MARIKO COLLETTA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****53

License Status

NOT RENEWED

Business

Title

DDS

First Name

STEPHANIE

Middle

MARIKO

Last Name

COLLETTA

Business Name

STEPHANIE MARIKO COLLETTA DDS

Original Issue Date

08/02/2011

Effective Date

08/27/2012

Expiration Date

09/30/2015

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/08/2016