DECLAN P FURLONG Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001396

License Status

EXPIRED

Business

First Name

DECLAN

Middle

Last Name

FURLONG

Business Name

DECLAN P FURLONG

Original Issue Date

05/23/2003

Effective Date

05/23/2003

Expiration Date

06/30/2003

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

Advanced General Dentistry

Ever Disciplined

LastModifiedDate

10/12/2005