MYRANDA NYCOLE WOLFF Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

ACTIVE

Business

First Name

MYRANDA

Middle

NYCOLE

Last Name

WOLFF

Business Name

MYRANDA NYCOLE WOLFF

Original Issue Date

09/17/2021

Effective Date

06/25/2024

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

06/25/2024