DIVYA R KRISHNA DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****01

License Status

INACTIVE

Business

Title

DMD

First Name

DIVYA

Middle

Last Name

KRISHNA

Business Name

DIVYA R KRISHNA DMD

Original Issue Date

08/03/2006

Effective Date

09/24/2018

Expiration Date

12/31/2021

City

ROUND LAKE

State

Zip

60073

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/29/2021