SHANE MICHAEL VAN VLEET DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****26

License Status

NOT RENEWED

Business

First Name

SHANE

Middle

MICHAEL

Last Name

VAN VLEET

Suffix

DMD

Business Name

SHANE MICHAEL VAN VLEET DMD

Original Issue Date

08/20/2007

Effective Date

09/07/2012

Expiration Date

09/30/2015

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016