THEODORE LEE MOSS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

First Name

THEODORE

Middle

LEE

Last Name

MOSS

Suffix

DMD

Business Name

THEODORE LEE MOSS DMD

Original Issue Date

11/24/1992

Effective Date

11/24/1992

Expiration Date

09/30/2000

City

STERLING

State

Zip

61081

County

WHITESIDE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005