ELFATIH EISA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

ACTIVE

Business

First Name

ELFATIH

Last Name

EISA

Business Name

ELFATIH EISA

Original Issue Date

11/17/2024

Effective Date

11/17/2024

Expiration Date

09/30/2027

City

EDWARDSVILLE

State

Zip

62025

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2025