BLAKE THOMAS WESTRA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****92

License Status

ACTIVE

Business

First Name

BLAKE

Middle

THOMAS

Last Name

WESTRA

Business Name

BLAKE THOMAS WESTRA

Original Issue Date

07/02/2009

Effective Date

10/01/2024

Expiration Date

09/30/2027

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/16/2024