THERON CORNELIUS WAISATH DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

ACTIVE

Business

Title

DMD

First Name

THERON

Middle

CORNELIUS

Last Name

WAISATH

Business Name

THERON CORNELIUS WAISATH DMD

Original Issue Date

03/04/2009

Effective Date

05/24/2024

Expiration Date

09/30/2027

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/24/2024