ANDREW ADIPUTRA - Dentist License in Illinois | # 31*****71

ANDREW ADIPUTRA

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****71

License Status

NOT RENEWED

Business

N

First Name

ANDREW

Last Name

ADIPUTRA

Business Name

ANDREW ADIPUTRA

Original Issue Date

08/15/2019

Effective Date

02/24/2022

Expiration Date

09/30/2024

State

IL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

07/01/2025