SIREESHA BOGANATHAM DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

NOT RENEWED

Business

First Name

SIREESHA

Last Name

BOGANATHAM

Suffix

DMD

Business Name

SIREESHA BOGANATHAM DMD

Original Issue Date

08/06/2012

Effective Date

09/28/2015

Expiration Date

09/30/2018

City

JANESVILLE

State

Zip

53545

County

WISCONSIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018