NATHANIEL JOSEPH PETERSON DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****38

License Status

ACTIVE

Business

Title

DMD

First Name

NATHANIEL

Middle

JOSEPH

Last Name

PETERSON

Business Name

NATHANIEL JOSEPH PETERSON DMD

Original Issue Date

08/28/2025

Effective Date

08/28/2025

Expiration Date

09/30/2027

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/28/2025