MARISSA E DZIEPAK Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****68

License Status

ACTIVE

Business

First Name

MARISSA

Middle

Last Name

DZIEPAK

Business Name

MARISSA E DZIEPAK

Original Issue Date

07/02/2018

Effective Date

06/05/2024

Expiration Date

09/30/2027

City

FRANKFORT

State

Zip

60423

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/05/2024