KELLY ANN CUSACK DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

ACTIVE

Business

Title

DMD

First Name

KELLY

Middle

ANN

Last Name

CUSACK

Business Name

KELLY ANN CUSACK DMD

Original Issue Date

07/23/2021

Effective Date

05/04/2024

Expiration Date

09/30/2027

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2024