BART JOHN KOSTRUBALA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

NOT RENEWED

Business

First Name

BART JOHN

Last Name

KOSTRUBALA

Business Name

BART JOHN KOSTRUBALA

Original Issue Date

01/01/1998

Expiration Date

09/30/2004

City

OAK LAWN

State

Zip

60453

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005