KIMBERLY ANNE BAPTIST DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****76

License Status

NOT RENEWED

Business

Title

DMD

First Name

KIMBERLY

Middle

ANNE

Last Name

BAPTIST

Business Name

KIMBERLY ANNE BAPTIST DMD

Original Issue Date

06/27/2016

Effective Date

12/11/2018

Expiration Date

01/31/2022

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022