ALLISON JEANNE LONG DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****17

License Status

ACTIVE

Business

Title

DMD

First Name

ALLISON

Middle

JEANNE

Last Name

LONG

Business Name

ALLISON JEANNE LONG DMD

Original Issue Date

06/28/2022

Effective Date

08/05/2024

Expiration Date

09/30/2027

City

CHATHAM

State

Zip

62629

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/05/2024