ANTONIO L DOMANTAY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

NOT RENEWED

Business

First Name

ANTONIO L

Last Name

DOMANTAY

Business Name

ANTONIO L DOMANTAY

Original Issue Date

07/28/1982

Effective Date

07/28/1982

Expiration Date

09/30/2000

City

CHICAGO

State

Zip

60641

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005