VITO P LA SUSA DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****59

License Status

ACTIVE

Business

First Name

VITO

Middle

Last Name

LA SUSA

Suffix

DDS

Business Name

VITO P LA SUSA DDS

Original Issue Date

08/30/1999

Effective Date

08/16/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60602

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/16/2024