THEODORE LEE MOSS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015769

License Status

NOT RENEWED

Business

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

City

STERLING

State

Zip

61081

County

WHITESIDE

Ever Disciplined

LastModifiedDate

10/31/2018