SCOTT MATHEW PETERSON Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021002109

License Status

ACTIVE

Business

First Name

SCOTT

Middle

MATHEW

Last Name

PETERSON

Business Name

SCOTT MATHEW PETERSON

Original Issue Date

08/11/2004

Effective Date

05/20/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Specialty/Qualifier

Orthodontics

Ever Disciplined

LastModifiedDate

05/20/2024