TSBDE Dentist: JEFFERSON, BETHANIEL SHEBA # 21310

License Number 21310
License Status Revoked
License Issue Date 05/30/2003
License Expiration Date 05/31/2016
 
 
Last Name JEFFERSON
Former Last Name JEFFERSON
First Name BETHANIEL
Middle Name SHEBA
Gender Female
City SPRING
State TX
Zip Code 77386
County MONTGOMERY
 
 
Nitrous Certification Date 06/20/2003
Anesthesia Level 1 Permit Issue Date 04/12/2007
Anesthesia Level 2 Permit Issue Date 05/04/2015
Anesthesia Level 3 Permit Issue Date No Permit
Anesthesia Level 4 Permit Issue Date No Permit
 
 
Type of Practice GEN
Year Graduated 2003
Dental School UMKC
Year of Birth 1977
 
 
Public Actions
Disciplinary Action Yes
Disciplinary Action PDFs 21310_Jefferson_Bethaniel_04-29-2005.pdf - 21310_Jefferson_Bethaniel_08-10-2012.pdf - 21310_JEFFERSON_Bethaniel_11-18-2016.pdf -
Remedial Plans No
Remedial Plan PDFs

CERTIFICATION OF INFORMATION: The Texas State Board of Dental Examiners certifies that it maintains the information for the license verification functions of this website, performs daily updates to the website and considers the website to be a secure, primary source for license verification.

Codes for Type of Practice

DPH=Dental Public Health
END=Endodontics
GEN=General Dentistry
OMP=Oral&Maxillofacial Pathology
OMR=Oral&Maxillofacial Radiology
OMS=Oral&Maxillofacial Surgery
ORTH=Orthodontics
PEDO=Pediatric Dentistry
PERI=Periodontics
PROS=Prosthodontics