ANITA MARY SHADE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000188

License Status

NOT RENEWED

Business

First Name

ANITA

Middle

MARY

Last Name

SHADE

Business Name

ANITA MARY SHADE

Original Issue Date

07/05/2013

Effective Date

07/05/2013

Expiration Date

06/30/2016

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

03/09/2017