IVAN LESTER STALEY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021000264

License Status

NOT RENEWED

Business

First Name

IVAN LESTER

Last Name

STALEY

Suffix

DDS

Business Name

IVAN LESTER STALEY DDS

Original Issue Date

01/10/1958

Effective Date

01/10/1958

Expiration Date

09/30/1984

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

Orthodontics

Ever Disciplined

LastModifiedDate

10/13/2005