PREETI A SHIVAKUMAR Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****62

License Status

ACTIVE

Business

First Name

PREETI

Middle

Last Name

SHIVAKUMAR

Business Name

PREETI A SHIVAKUMAR

Original Issue Date

08/10/2009

Effective Date

09/12/2024

Expiration Date

09/30/2027

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/12/2024