JACK CAPODICE JR Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

NOT RENEWED

Business

First Name

JACK

Last Name

CAPODICE JR

Business Name

JACK CAPODICE JR

Original Issue Date

03/18/1993

Effective Date

03/18/1993

Expiration Date

09/30/1996

City

LINCOLN

State

Zip

62656

County

LOGAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005