STACY R MOODY DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****25

License Status

ACTIVE

Business

First Name

STACY

Middle

Last Name

MOODY

Suffix

DMD

Business Name

STACY R MOODY DMD

Original Issue Date

09/15/2004

Effective Date

08/30/2024

Expiration Date

09/30/2027

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/30/2024