TY GREEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****01

License Status

NOT RENEWED

Business

Title

DDS

First Name

Last Name

GREEN

Business Name

TY GREEN DDS

Original Issue Date

07/21/2023

Effective Date

07/21/2023

Expiration Date

09/30/2024

City

BOURBONNAIS

State

Zip

60914

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025