TIFFANY ELISA ANDERSEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

NOT RENEWED

Business

First Name

TIFFANY

Middle

ELISA

Last Name

ANDERSEN

Business Name

TIFFANY ELISA ANDERSEN

Original Issue Date

08/06/2010

Effective Date

08/06/2010

Expiration Date

09/30/2012

City

GILBERT

State

Zip

85296

County

ARIZONA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012