MARY ANN SOUTHERLAN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020004826

License Status

ACTIVE

Business

First Name

MARY ANN

Last Name

SOUTHERLAN

Business Name

MARY ANN SOUTHERLAN

Original Issue Date

06/28/1982

Effective Date

09/22/2024

Expiration Date

09/30/2027

City

MOUNT PULASKI

State

Zip

62548

County

LOGAN

Ever Disciplined

LastModifiedDate

09/22/2024