BEAU GARRET MOODY DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000860

License Status

NOT RENEWED

Business

First Name

BEAU

Middle

GARRET

Last Name

MOODY

Suffix

DMD

Business Name

BEAU GARRET MOODY DMD

Original Issue Date

01/02/2013

Effective Date

10/01/2015

Expiration Date

09/30/2018

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

10/31/2018