JETHRO BLACK JR Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019021708

License Status

NOT RENEWED

Business

First Name

JETHRO

Last Name

BLACK JR

Business Name

JETHRO BLACK JR

Original Issue Date

08/25/1989

Effective Date

08/25/1989

Expiration Date

09/30/1996

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

01/11/2012

Case Number

2011011160

Action

Revocation

Discipline Start Date

01/11/2012

Discipline Reason

due to requirement as part of a criminal sentence to register under the Sex Offender Registration Act.