ANGELINA VALERIE ANISIMOVA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

NOT RENEWED

Business

First Name

ANGELINA

Middle

VALERIE

Last Name

ANISIMOVA

Suffix

DDS

Business Name

ANGELINA VALERIE ANISIMOVA DDS

Original Issue Date

07/30/2003

Effective Date

07/30/2003

Expiration Date

09/30/2004

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005