JOHN M FORMELLER Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

ACTIVE

Business

First Name

JOHN M

Last Name

FORMELLER

Business Name

JOHN M FORMELLER

Original Issue Date

02/09/1989

Effective Date

07/30/2024

Expiration Date

09/30/2027

City

NORTHBROOK

State

Zip

60062

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/30/2024