MICHAEL D MONTAGNA DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

Last Name

MONTAGNA

Suffix

DMD

Business Name

MICHAEL D MONTAGNA DMD

Original Issue Date

01/03/2006

Effective Date

01/03/2006

Expiration Date

09/30/2006

City

CHICAGO

State

Zip

60647

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006