JACK EDWARD JORDAN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

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

09/30/1986

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005