DAVID R PETERSON DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****98

License Status

CANCELLED

Business

First Name

DAVID R

Last Name

PETERSON

Suffix

DDS

Business Name

DAVID R PETERSON DDS

Original Issue Date

07/15/2020

Effective Date

07/15/2020

Expiration Date

12/31/2021

City

YORKVILLE

State

Zip

60560

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/11/2021