KATHERINE MAE SHADID Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****75

License Status

ACTIVE

Business

First Name

KATHERINE

Middle

MAE

Last Name

SHADID

Business Name

KATHERINE MAE SHADID

Original Issue Date

07/19/2024

Effective Date

07/19/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61615

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2024