DAVID R PETERSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

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

01/31/2022

City

MACHESNEY PARK

State

Zip

61115

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022