SUSAN J SUP DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

First Name

SUSAN J

Last Name

SUP DDS

Business Name

SUSAN J SUP DDS

Original Issue Date

01/01/1998

Effective Date

11/19/2021

Expiration Date

09/30/2024

City

OTTAWA

State

Zip

61350

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025