SUSAN L GOLDSTEIN DMD 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

SUSAN L

Last Name

GOLDSTEIN

Suffix

DMD

Business Name

SUSAN L GOLDSTEIN DMD

Original Issue Date

12/06/1984

Effective Date

09/07/2018

Expiration Date

01/31/2022

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022