JETHRO BLACK JR Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000388

License Status

NOT RENEWED

Business

First Name

JETHRO

Last Name

BLACK JR

Business Name

JETHRO BLACK JR

Original Issue Date

07/18/1989

Effective Date

07/18/1989

Expiration Date

06/30/1990

City

EAST ST LOUIS

State

Zip

62201

County

SAINT CLAIR

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005