ASHLEY ROSE GOLDMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

NOT RENEWED

Business

First Name

ASHLEY

Middle

ROSE

Last Name

GOLDMAN

Business Name

ASHLEY ROSE GOLDMAN

Original Issue Date

06/03/2022

Effective Date

06/03/2022

Expiration Date

09/30/2024

City

CHAMPAIGN

State

Zip

61822

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025