STACI M SHAW Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020009887

License Status

ACTIVE

Business

First Name

STACI

Middle

Last Name

SHAW

Business Name

STACI M SHAW

Original Issue Date

08/03/2000

Effective Date

09/27/2024

Expiration Date

09/30/2027

City

MAHOMET

State

Zip

61853

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/27/2024