ANEETAM BASSI Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****74

License Status

NOT RENEWED

Business

First Name

ANEETAM

Last Name

BASSI

Business Name

ANEETAM BASSI

Original Issue Date

12/14/2021

Effective Date

12/14/2021

Expiration Date

09/30/2024

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025