SANDEEP THOTA DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****31

License Status

ACTIVE

Business

Title

DMD

First Name

SANDEEP

Last Name

THOTA

Business Name

SANDEEP THOTA DMD

Original Issue Date

07/16/2015

Effective Date

05/03/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/03/2024