RYAN J COLLETTA 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

RYAN

Middle

Last Name

COLLETTA

Business Name

RYAN J COLLETTA

Original Issue Date

07/11/2012

Effective Date

07/11/2012

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

02/08/2016