TY A PARKER Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

ACTIVE

Business

First Name

Middle

Last Name

PARKER

Business Name

TY A PARKER

Original Issue Date

08/10/2007

Effective Date

05/22/2024

Expiration Date

09/30/2027

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/22/2024