MARY GRACE TEKAWITHA NORA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****63

License Status

NOT RENEWED

Business

Title

DMD

First Name

MARY GRACE

Middle

TEKAWITHA

Last Name

NORA

Business Name

MARY GRACE TEKAWITHA NORA DMD

Original Issue Date

07/12/2016

Effective Date

08/16/2018

Expiration Date

01/31/2022

City

LA GRANGE

State

Zip

60525

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/09/2022