ALEXANDRA BACON SMITH DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

NOT RENEWED

Business

Title

DMD

First Name

ALEXANDRA

Middle

BACON

Last Name

SMITH

Business Name

ALEXANDRA BACON SMITH DMD

Original Issue Date

05/29/2013

Effective Date

05/29/2013

Expiration Date

09/30/2015

City

CHARLESTON

State

Zip

61920

County

COLES

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016