KHEYA SAM PATEL Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****34

License Status

ACTIVE

Business

First Name

KHEYA

Middle

SAM

Last Name

PATEL

Business Name

KHEYA SAM PATEL

Original Issue Date

10/29/2023

Effective Date

10/01/2024

Expiration Date

09/30/2027

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/16/2024