ELIZABETH SUSAN LANSFORD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

Business

First Name

ELIZABETH

Middle

SUSAN

Last Name

LANSFORD

Business Name

ELIZABETH SUSAN LANSFORD

Original Issue Date

06/17/2011

Effective Date

06/17/2011

Expiration Date

09/30/2012

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012