SUSAN BORDENAVE-BISHOP Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****56

License Status

ACTIVE

Business

First Name

SUSAN

Last Name

BORDENAVE-BISHOP

Business Name

SUSAN BORDENAVE-BISHOP

Original Issue Date

10/29/1987

Effective Date

07/30/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/30/2024