STACEY L KIDD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011262

License Status

NOT RENEWED

Business

First Name

STACEY

Middle

Last Name

KIDD

Business Name

STACEY L KIDD

Original Issue Date

03/23/2005

Effective Date

09/23/2015

Expiration Date

09/30/2018

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/31/2018