JESS FOWLER HAVRON DMD Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000147

License Status

EXPIRED

Business

First Name

JESS

Middle

FOWLER

Last Name

HAVRON

Suffix

DMD

Business Name

JESS FOWLER HAVRON DMD

Original Issue Date

03/31/2010

Effective Date

07/01/2010

Expiration Date

06/30/2012

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

08/29/2012