DONALD J STATEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****23

License Status

NOT RENEWED

Business

First Name

DONALD J

Last Name

STATEN

Business Name

DONALD J STATEN

Original Issue Date

07/27/1987

Effective Date

01/10/2007

Expiration Date

09/30/2009

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009