RAVEN-DENEICE GRANT CAROUTHERS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****62

License Status

NOT RENEWED

Business

First Name

RAVEN-DENEICE

Middle

GRANT

Last Name

CAROUTHERS

Business Name

RAVEN-DENEICE GRANT CAROUTHERS

Original Issue Date

07/30/2020

Effective Date

12/11/2021

Expiration Date

09/30/2024

City

MCHENRY

State

Zip

60051

County

MCHENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025