JACK BAKER BURRELL DDS Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****19

License Status

INOPERATIVE

Business

First Name

JACK BAKER

Last Name

BURRELL

Suffix

DDS

Business Name

JACK BAKER BURRELL DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1998

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/13/2005