MARISA RUGINO DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

CANCELLED

Business

Title

DMD

First Name

MARISA

Last Name

RUGINO

Business Name

MARISA RUGINO DMD

Original Issue Date

07/31/2020

Effective Date

07/31/2020

Expiration Date

12/31/2021

City

LA GRANGE

State

Zip

60525

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/11/2021