MICHAEL C DEFAZIO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

Last Name

DEFAZIO

Business Name

MICHAEL C DEFAZIO

Original Issue Date

10/03/2013

Effective Date

10/03/2013

Expiration Date

09/30/2015

City

GREAT LAKES

State

Zip

60088

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016