DEONTAY LEESEAN CRAWFORD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

ACTIVE

Business

First Name

DEONTAY

Middle

LEESEAN

Last Name

CRAWFORD

Business Name

DEONTAY LEESEAN CRAWFORD

Original Issue Date

06/20/2017

Effective Date

09/08/2024

Expiration Date

09/30/2027

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/08/2024