NATHANAEL DAVID BENASSI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

Title

DDS

First Name

NATHANAEL

Middle

DAVID

Last Name

BENASSI

Business Name

NATHANAEL DAVID BENASSI DDS

Original Issue Date

09/11/2013

Effective Date

12/16/2021

Expiration Date

09/30/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025