DONALD J PROVENZALE JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

DONALD

Middle

Last Name

PROVENZALE

Suffix

JR DDS

Business Name

DONALD J PROVENZALE JR DDS

Original Issue Date

01/04/1993

Effective Date

01/04/1993

Expiration Date

09/30/1994

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005