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Licensed Professional Information:
Dentist 2901016219

Licensee Detail

License Type:

Dentist

License Number:

2901016219

Name:

Shiva Goltalab-Rad

License Issue Date:

02/08/1993

License Expiration Date:

02/08/2027

License Status:

Active

County:

Washtenaw

CONTROLLED SUBSTANCE LIST

City:

Ann Arbor

State or Province:

Michigan

ZIP or Postal Code:

48105

CS Record Number:

5315161313

CS Status:

Active

CS Expiration Date:

02/08/2027

Related Records

Listed below are the records associated with

Dentist,

License Number:

2901016219

Record list

Showing 1-3 of 3

Date

Record Number

Record Type

02/08/1993

2901016219

Dentist License

03/10/2025

COM25-001603

Complaint

05/02/2025

29-25-001750

Enforcement

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