DEREK JOHN BENNING DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

ACTIVE

Business

Title

DMD

First Name

DEREK

Middle

JOHN

Last Name

BENNING

Business Name

DEREK JOHN BENNING DMD

Original Issue Date

07/02/2022

Effective Date

09/04/2024

Expiration Date

09/30/2027

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/04/2024