TAYLOR PETRICH DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****26

License Status

ACTIVE

Business

Title

DMD

First Name

TAYLOR

Last Name

PETRICH

Business Name

TAYLOR PETRICH DMD

Original Issue Date

07/21/2020

Effective Date

07/12/2024

Expiration Date

09/30/2027

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/12/2024