MANOGNA DEEPTHI YAKASIRI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

NOT RENEWED

Business

Title

DDS

First Name

MANOGNA

Middle

DEEPTHI

Last Name

YAKASIRI

Business Name

MANOGNA DEEPTHI YAKASIRI DDS

Original Issue Date

09/04/2019

Effective Date

12/31/2021

Expiration Date

09/30/2024

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025