KEVIN THOMAS MOSS DMD 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

KEVIN

Middle

THOMAS

Last Name

MOSS

Suffix

DMD

Business Name

KEVIN THOMAS MOSS DMD

Original Issue Date

08/14/2003

Effective Date

08/14/2003

Expiration Date

09/30/2006

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006