GREGORY K SPACKMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

NOT RENEWED

Business

First Name

GREGORY K

Last Name

SPACKMAN

Business Name

GREGORY K SPACKMAN

Original Issue Date

04/19/1990

Effective Date

04/19/1990

Expiration Date

09/30/1994

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005