MYRANDA NYCOLE WOLFF Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

MYRANDA

Middle

NYCOLE

Last Name

WOLFF

Business Name

MYRANDA NYCOLE WOLFF

Original Issue Date

09/20/2018

Effective Date

09/20/2018

Expiration Date

01/31/2022

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022