KELLIE LOUISE BLACK Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020012076

License Status

ACTIVE

Business

First Name

KELLIE

Middle

LOUISE

Last Name

BLACK

Business Name

KELLIE LOUISE BLACK

Original Issue Date

06/15/2007

Effective Date

08/21/2024

Expiration Date

09/30/2027

City

MACHESNEY PARK

State

Zip

61115

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

08/21/2024