ROBERT DUANE DOUGLAS DMD Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000055

License Status

EXPIRED

Business

First Name

ROBERT

Middle

DUANE

Last Name

DOUGLAS

Suffix

DMD

Business Name

ROBERT DUANE DOUGLAS DMD

Original Issue Date

10/14/1998

Effective Date

10/14/1998

Expiration Date

01/14/2004

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

10/13/2005