DONALD J PROVENZALE JR DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****92

License Status

ACTIVE

Business

First Name

DONALD

Middle

Last Name

PROVENZALE

Suffix

JR DDS

Business Name

DONALD J PROVENZALE JR DDS

Original Issue Date

08/11/1988

Effective Date

07/26/2024

Expiration Date

09/30/2027

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/26/2024