SHRUTI DHIRENDRA VASANI Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****59

License Status

ACTIVE

Business

First Name

SHRUTI

Middle

DHIRENDRA

Last Name

VASANI

Business Name

SHRUTI DHIRENDRA VASANI

Original Issue Date

12/16/2024

Effective Date

12/16/2024

Expiration Date

09/30/2027

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

02/24/2025