MARYAM RUBY KISHTA DERANI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****24

License Status

NOT RENEWED

Business

Title

DDS

First Name

MARYAM

Middle

RUBY

Last Name

KISHTA DERANI

Business Name

MARYAM RUBY KISHTA DERANI DDS

Original Issue Date

08/25/2008

Effective Date

12/02/2015

Expiration Date

09/30/2018

City

GRAND BLANC

State

Zip

48439

County

MICHIGAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/31/2018