TIEG B SELBERG DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

Title

DDS

First Name

TIEG

Middle

Last Name

SELBERG

Business Name

TIEG B SELBERG DDS

Original Issue Date

09/21/2018

Effective Date

10/05/2021

Expiration Date

09/30/2024

City

BELLEVILLE

State

Zip

62226

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025