ELISA MARIE ROTH DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****38

License Status

ACTIVE

Business

First Name

ELISA

Middle

MARIE

Last Name

ROTH

Suffix

DMD

Business Name

ELISA MARIE ROTH DMD

Original Issue Date

06/23/2015

Effective Date

07/09/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61701

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/09/2024