KENNETH DALE REPINE DDS 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

KENNETH DALE

Last Name

REPINE

Suffix

DDS

Business Name

KENNETH DALE REPINE DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1986

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/13/2005