GOLNESA ROUIE MIAB DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****95

License Status

NOT RENEWED

Business

Title

DDS

First Name

GOLNESA

Last Name

ROUIE MIAB

Business Name

GOLNESA ROUIE MIAB DDS

Original Issue Date

07/14/2021

Effective Date

07/14/2021

Expiration Date

09/30/2024

City

EAST SAINT LOUIS

State

Zip

62205

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

02/04/2025