JERRY ADIEL DOUGLAS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013588

License Status

NOT RENEWED

Business

First Name

JERRY ADIEL

Last Name

DOUGLAS

Suffix

DMD

Business Name

JERRY ADIEL DOUGLAS DMD

Original Issue Date

07/14/1969

Effective Date

07/14/1969

Expiration Date

09/30/2002

City

HARRISBURG

State

Zip

62946

County

SALINE

Ever Disciplined

LastModifiedDate

10/17/2005

Case Number

1984000697

Action

Probation

Discipline Start Date

09/20/1985

Discipline End Date

09/20/1986