DANIEL J MOFFETT Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000293

License Status

INACTIVE

Business

First Name

DANIEL

Middle

Last Name

MOFFETT

Business Name

DANIEL J MOFFETT

Original Issue Date

04/12/1991

Effective Date

04/12/1991

Expiration Date

09/30/2004

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

10/17/2005