ERIC MATTHEW FOSS DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000109

License Status

EXPIRED

Business

First Name

ERIC

Middle

MATTHEW

Last Name

FOSS

Suffix

DDS

Business Name

ERIC MATTHEW FOSS DDS

Original Issue Date

06/09/2005

Effective Date

06/09/2005

Expiration Date

06/30/2007

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

07/03/2007