MARCIO ANTONIO DA FONSECA DDS Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****82

License Status

INOPERATIVE

Business

Title

DDS

First Name

MARCIO

Middle

ANTONIO

Last Name

DA FONSECA

Business Name

MARCIO ANTONIO DA FONSECA DDS

Original Issue Date

09/13/2016

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024