KELISSA PETERSON DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

ACTIVE

Business

Title

DMD

First Name

KELISSA

Last Name

PETERSON

Business Name

KELISSA PETERSON DMD

Original Issue Date

10/19/2021

Effective Date

05/17/2024

Expiration Date

09/30/2027

City

SHERIDAN

State

Zip

60551

County

LA SALLE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/17/2024