PHILLIP M JENSEN DMD 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

PHILLIP

Middle

Last Name

JENSEN

Suffix

DMD

Business Name

PHILLIP M JENSEN DMD

Original Issue Date

08/03/1993

Effective Date

08/03/1993

Expiration Date

09/30/1994

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005