DOUGLAS D KIRK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****25

License Status

NOT RENEWED

Business

First Name

DOUGLAS D

Last Name

KIRK

Business Name

DOUGLAS D KIRK

Original Issue Date

08/25/1986

Effective Date

07/17/2012

Expiration Date

09/30/2015

City

LAWRENCEVILLE

State

Zip

62439

County

LAWRENCE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016