SANDERS MIDDLETO MOODY 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

SANDERS MIDDLETO

Last Name

MOODY

Business Name

SANDERS MIDDLETO MOODY

Original Issue Date

08/23/1984

Effective Date

08/23/1984

Expiration Date

09/30/1996

City

CHICAGO

State

Zip

60619

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005