JACK J MILLER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019014362

License Status

NOT RENEWED

Business

Title

DDS

First Name

JACK

Middle

Last Name

MILLER

Business Name

JACK J MILLER DDS

Original Issue Date

07/12/1972

Effective Date

06/04/2009

Expiration Date

09/30/2012

City

GRANITE CITY

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

11/14/2012