BEAU GARRET MOODY DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****23

License Status

ACTIVE

Business

First Name

BEAU

Middle

GARRET

Last Name

MOODY

Suffix

DMD

Business Name

BEAU GARRET MOODY DMD

Original Issue Date

10/09/2009

Effective Date

07/29/2024

Expiration Date

09/30/2027

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/29/2024