STACIE DIANE BEASLEY DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****91

License Status

ACTIVE

Business

Title

DDS

First Name

STACIE

Middle

DIANE

Last Name

BEASLEY

Business Name

STACIE DIANE BEASLEY DDS

Original Issue Date

09/06/2011

Effective Date

09/30/2024

Expiration Date

09/30/2027

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/30/2024