JACK EDWARD JORDAN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000063

License Status

NOT RENEWED

Business

First Name

JACK EDWARD

Last Name

JORDAN

Suffix

DMD

Business Name

JACK EDWARD JORDAN DMD

Original Issue Date

01/01/1998

Expiration Date

09/30/1998

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

10/13/2005