KIIRI TAMM TIETJENS DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****65

License Status

NOT RENEWED

Business

First Name

KIIRI

Middle

TAMM

Last Name

TIETJENS

Suffix

DDS

Business Name

KIIRI TAMM TIETJENS DDS

Original Issue Date

12/13/2005

Effective Date

09/11/2021

Expiration Date

09/30/2024

City

BOURBONNAIS

State

Zip

60914

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025