DIANNA G GAULTNEY Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

ACTIVE

Business

First Name

DIANNA G

Last Name

GAULTNEY

Business Name

DIANNA G GAULTNEY

Original Issue Date

07/20/1988

Effective Date

08/26/2024

Expiration Date

09/30/2027

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/26/2024