SHANTHI NALLASAMY DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

ACTIVE

Business

First Name

SHANTHI

Last Name

NALLASAMY

Suffix

DMD

Business Name

SHANTHI NALLASAMY DMD

Original Issue Date

10/17/2007

Effective Date

09/19/2024

Expiration Date

09/30/2027

City

HAWTHORN WOODS

State

Zip

60047

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/19/2024