SRINIVAS BABU GHANTA DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****71

License Status

CANCELLED

Business

First Name

SRINIVAS

Middle

BABU

Last Name

GHANTA

Suffix

DMD

Business Name

SRINIVAS BABU GHANTA DMD

Original Issue Date

09/19/2003

Effective Date

09/19/2003

Expiration Date

09/30/2006

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006