LISA A BUSH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

NOT RENEWED

Business

First Name

LISA A

Last Name

BUSH

Business Name

LISA A BUSH

Original Issue Date

04/09/2003

Effective Date

09/18/2012

Expiration Date

09/30/2015

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016