KELISSA PETERSON DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****50

License Status

NOT RENEWED

Business

Title

DMD

First Name

KELISSA

Last Name

PETERSON

Business Name

KELISSA PETERSON DMD

Original Issue Date

08/27/2019

Effective Date

08/27/2019

Expiration Date

01/31/2022

City

SHERIDAN

State

Zip

60551

County

LA SALLE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022