JACK J MILLER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

Title

DDS

First Name

JACK

Middle

Last Name

MILLER

Business Name

JACK J MILLER DDS

Original Issue Date

01/01/1998

Effective Date

06/04/2009

Expiration Date

09/30/2012

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012