JASON MANTLE KOCH DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

CANCELLED

Business

First Name

JASON

Middle

MANTLE

Last Name

KOCH

Suffix

DMD

Business Name

JASON MANTLE KOCH DMD

Original Issue Date

03/08/2000

Effective Date

03/08/2000

Expiration Date

09/30/2002

City

TAMMS

State

Zip

62988

County

ALEXANDER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005