DIBYENDU PRIYAKA MEHTA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

ACTIVE

Business

First Name

DIBYENDU PRIYAKA

Last Name

MEHTA

Business Name

DIBYENDU PRIYAKA MEHTA

Original Issue Date

08/10/1983

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024