DOUGLAS MARTIN KELLER Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****67

License Status

ACTIVE

Business

First Name

DOUGLAS

Middle

MARTIN

Last Name

KELLER

Business Name

DOUGLAS MARTIN KELLER

Original Issue Date

09/26/2018

Effective Date

09/26/2024

Expiration Date

09/30/2027

City

MANTENO

State

Zip

60950

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2024