PETER G GREEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****66

License Status

NOT RENEWED

Business

First Name

PETER G

Last Name

GREEN

Business Name

PETER G GREEN

Original Issue Date

11/02/1988

Effective Date

11/02/1988

Expiration Date

09/30/1990

City

KINGMAN

State

Zip

86401

County

ARIZONA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005