PHOEBE MARIE BLAKELEY Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018002094

License Status

EXPIRED

Business

First Name

PHOEBE

Middle

MARIE

Last Name

BLAKELEY

Business Name

PHOEBE MARIE BLAKELEY

Original Issue Date

01/15/2019

Effective Date

01/31/2019

Expiration Date

06/30/2021

City

ALTON

State

Zip

62002

Specialty/Qualifier

Advanced General Dentistry

Ever Disciplined

LastModifiedDate

11/28/2022