THERON CORNELIUS WAISATH DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000758

License Status

ACTIVE

Business

Title

DMD

First Name

THERON

Middle

CORNELIUS

Last Name

WAISATH

Business Name

THERON CORNELIUS WAISATH DMD

Original Issue Date

07/30/2009

Effective Date

05/24/2024

Expiration Date

09/30/2027

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

05/24/2024