NICOLE MARIE SUDHOLT Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****28

License Status

ACTIVE

Business

First Name

NICOLE

Middle

MARIE

Last Name

SUDHOLT

Business Name

NICOLE MARIE SUDHOLT

Original Issue Date

06/08/2010

Effective Date

08/19/2024

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

08/19/2024