VIJAYA LAKSHMI BATHINA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****63

License Status

NOT RENEWED

Business

Title

DMD

First Name

VIJAYA

Middle

LAKSHMI

Last Name

BATHINA

Business Name

VIJAYA LAKSHMI BATHINA DMD

Original Issue Date

07/27/2012

Effective Date

07/27/2012

Expiration Date

09/30/2015

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016