TIMOTHY JOHN LONGO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****95

License Status

NOT RENEWED

Business

Title

DDS

First Name

TIMOTHY

Middle

JOHN

Last Name

LONGO

Business Name

TIMOTHY JOHN LONGO DDS

Original Issue Date

08/14/2017

Effective Date

09/19/2018

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60614

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/09/2022