KETKI B DESAI Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

NOT RENEWED

Business

First Name

KETKI B

Last Name

DESAI

Business Name

KETKI B DESAI

Original Issue Date

04/22/1987

Effective Date

04/22/1987

Expiration Date

09/30/1990

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005