DENISE LEIGH LONG DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****21

License Status

NOT RENEWED

Business

First Name

DENISE

Middle

LEIGH

Last Name

LONG

Suffix

DMD

Business Name

DENISE LEIGH LONG DMD

Original Issue Date

07/31/2000

Effective Date

07/31/2000

Expiration Date

09/30/2006

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006