KELLY ANN CUSACK DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019033249

License Status

ACTIVE

Business

Title

DMD

First Name

KELLY

Middle

ANN

Last Name

CUSACK

Business Name

KELLY ANN CUSACK DMD

Original Issue Date

06/21/2021

Effective Date

05/04/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

05/04/2024