FELICIA S MATA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****83

License Status

NOT RENEWED

Business

First Name

FELICIA S

Last Name

MATA

Suffix

DMD

Business Name

FELICIA S MATA DMD

Original Issue Date

12/21/2021

Effective Date

12/21/2021

Expiration Date

09/30/2024

City

CHICAGO

State

Zip

60602

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025