DEREK H FORNELLI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****89

License Status

NOT RENEWED

Business

First Name

DEREK

Middle

Last Name

FORNELLI DDS

Business Name

DEREK H FORNELLI DDS

Original Issue Date

09/10/2009

Effective Date

10/01/2021

Expiration Date

09/30/2024

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Specialty/Qualifier

PRACTITIONER

Ever Disciplined

LastModifiedDate

02/04/2025