KELLY JAMES MOORE Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

ACTIVE

Business

First Name

KELLY JAMES

Last Name

MOORE

Business Name

KELLY JAMES MOORE

Original Issue Date

08/03/1983

Effective Date

06/11/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/11/2024