SHANNON M BHARGAVA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****95

License Status

NOT RENEWED

Business

First Name

SHANNON

Middle

Last Name

BHARGAVA

Business Name

SHANNON M BHARGAVA

Original Issue Date

08/03/2001

Effective Date

08/03/2001

Expiration Date

09/30/2004

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/17/2005