THARANI THEIVAKUMAR 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

THARANI

Last Name

THEIVAKUMAR

Business Name

THARANI THEIVAKUMAR DMD

Original Issue Date

08/13/2019

Effective Date

08/13/2019

Expiration Date

01/31/2022

City

LISLE

State

Zip

60532

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022