PAUL DOUGLAS LARSEN DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****90

License Status

ACTIVE

Business

First Name

PAUL

Middle

DOUGLAS

Last Name

LARSEN

Suffix

DDS

Business Name

PAUL DOUGLAS LARSEN DDS

Original Issue Date

03/16/1983

Effective Date

09/10/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61615

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/10/2024