ALISA MARIA TAYLOR DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000988

License Status

NOT RENEWED

Business

First Name

ALISA

Middle

MARIA

Last Name

TAYLOR

Suffix

DMD

Business Name

ALISA MARIA TAYLOR DMD

Original Issue Date

09/28/2017

Effective Date

12/16/2021

Expiration Date

09/30/2024

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

02/04/2025