PETER DAVID SMIDT DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****17

License Status

ACTIVE

Business

Title

DDS

First Name

PETER

Middle

DAVID

Last Name

SMIDT

Business Name

PETER DAVID SMIDT DDS

Original Issue Date

06/25/2014

Effective Date

09/13/2024

Expiration Date

09/30/2027

City

MORTON

State

Zip

61550

County

TAZEWELL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/13/2024