MICHAEL DAVID DEGOULD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****24

License Status

CANCELLED

Business

First Name

MICHAEL DAVID

Last Name

DEGOULD

Business Name

MICHAEL DAVID DEGOULD

Original Issue Date

08/24/1990

Effective Date

08/24/1990

Expiration Date

09/30/1992

City

BELVIDERE

State

Zip

61008

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005