PHILIP MICHAEL WORTHINGTON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001864

License Status

NOT RENEWED

Business

Title

DDS

First Name

PHILIP

Middle

MICHAEL

Last Name

WORTHINGTON

Business Name

PHILIP MICHAEL WORTHINGTON DDS

Original Issue Date

11/07/2012

Effective Date

01/31/2013

Expiration Date

06/30/2015

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

01/07/2016