THEODORE LEE MOSS DMD - Dentist License in Illinois | # 019015769

THEODORE LEE MOSS DMD

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015769

License Status

NOT RENEWED

Business

N

First Name

THEODORE

Middle

LEE

Last Name

MOSS

Suffix

DMD

Business Name

THEODORE LEE MOSS DMD

Original Issue Date

12/15/1976

Effective Date

07/06/2015

Expiration Date

09/30/2018

State

IL

Ever Disciplined

N

LastModifiedDate

10/31/2018