KATHY J SHAFER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****49

License Status

NOT RENEWED

Business

First Name

KATHY J

Last Name

SHAFER

Suffix

DMD

Business Name

KATHY J SHAFER DMD

Original Issue Date

03/12/2019

Effective Date

11/30/2021

Expiration Date

09/30/2024

City

EDWARDSVILLE

State

Zip

62026

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025