THEODORE LEE MOSS DMD 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

THEODORE

Middle

LEE

Last Name

MOSS

Suffix

DMD

Business Name

THEODORE LEE MOSS DMD

Original Issue Date

01/01/1998

Effective Date

06/06/2012

Expiration Date

09/30/2015

City

STERLING

State

Zip

61081

County

WHITESIDE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016