ANDREA LEE SULLIVAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****98

License Status

NOT RENEWED

Business

First Name

ANDREA

Middle

LEE

Last Name

SULLIVAN

Business Name

ANDREA LEE SULLIVAN

Original Issue Date

03/26/2018

Effective Date

09/22/2021

Expiration Date

09/30/2024

City

GLEN CARBON

State

Zip

62034

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025