DAVID R PETERSON DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

CANCELLED

Business

First Name

DAVID R

Last Name

PETERSON

Suffix

DDS

Business Name

DAVID R PETERSON DDS

Original Issue Date

01/27/2020

Effective Date

01/27/2020

Expiration Date

09/30/2021

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/27/2020