DAVID D DOMENELLA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

ACTIVE

Business

First Name

DAVID D

Last Name

DOMENELLA

Business Name

DAVID D DOMENELLA

Original Issue Date

10/07/1985

Effective Date

09/24/2024

Expiration Date

09/30/2027

City

RICHMOND

State

Zip

60071

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/24/2024