JEFFREY T JACOB Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

Last Name

JACOB

Business Name

JEFFREY T JACOB

Original Issue Date

07/16/2009

Effective Date

08/03/2015

Expiration Date

09/30/2018

City

MARION

State

Zip

62959

County

WILLIAMSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018