KEITH D STEWART Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

STEWART

Business Name

KEITH D STEWART

Original Issue Date

02/17/2010

Effective Date

06/15/2018

Expiration Date

01/31/2022

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022