STEPHEN P RUSSO DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****53

License Status

ACTIVE

Business

Title

DMD

First Name

STEPHEN

Middle

Last Name

RUSSO

Business Name

STEPHEN P RUSSO DMD

Original Issue Date

07/29/2004

Effective Date

08/12/2024

Expiration Date

09/30/2027

City

SKOKIE

State

Zip

60076

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/12/2024