ASHLEY DIANNA MAXAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****19

License Status

NOT RENEWED

Business

First Name

ASHLEY

Middle

DIANNA

Last Name

MAXAM

Business Name

ASHLEY DIANNA MAXAM

Original Issue Date

07/16/2009

Effective Date

08/28/2012

Expiration Date

09/30/2015

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016