MARIA GABRIELA RODRIGUEZ MANTILLA DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

ACTIVE

Business

Title

DDS

First Name

MARIA

Middle

GABRIELA

Last Name

RODRIGUEZ MANTILLA

Business Name

MARIA GABRIELA RODRIGUEZ MANTILLA DDS

Original Issue Date

12/13/2024

Effective Date

12/13/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2025