MARILYN SUSAN LANTZ 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

MARILYN SUSAN

Last Name

LANTZ

Business Name

MARILYN SUSAN LANTZ

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005