KAYATHRI PONNUSAMY DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****66

License Status

ACTIVE

Business

Title

DMD

First Name

KAYATHRI

Last Name

PONNUSAMY

Business Name

KAYATHRI PONNUSAMY DMD

Original Issue Date

06/28/2024

Effective Date

06/28/2024

Expiration Date

09/30/2027

City

BOLINGBROOK

State

Zip

60490

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/28/2024