PHILLIP T MARUCHA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****90

License Status

NOT RENEWED

Business

First Name

PHILLIP

Middle

Last Name

MARUCHA

Suffix

DMD

Business Name

PHILLIP T MARUCHA DMD

Original Issue Date

12/06/2004

Effective Date

06/20/2012

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016