ALEXANDRA BACON SMITH DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019029389

License Status

INACTIVE

Business

Title

DMD

First Name

ALEXANDRA

Middle

BACON

Last Name

SMITH

Business Name

ALEXANDRA BACON SMITH DMD

Original Issue Date

05/29/2013

Effective Date

05/29/2013

Expiration Date

09/30/2015

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

06/08/2015