ALVIN DERRICK WEATHERFORD JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

First Name

ALVIN

Middle

DERRICK

Last Name

WEATHERFORD

Suffix

JR DDS

Business Name

ALVIN DERRICK WEATHERFORD JR DDS

Original Issue Date

10/30/2007

Effective Date

08/06/2018

Expiration Date

01/31/2022

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022