KELLY DIANE LATTAN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020010606

License Status

ACTIVE

Business

First Name

KELLY

Middle

DIANE

Last Name

LATTAN

Business Name

KELLY DIANE LATTAN

Original Issue Date

06/17/2003

Effective Date

09/22/2024

Expiration Date

09/30/2027

City

MURPHYSBORO

State

Zip

62966

Ever Disciplined

LastModifiedDate

09/22/2024