ROBERT DUANE DOUGLAS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****28

License Status

NOT RENEWED

Business

First Name

ROBERT

Middle

DUANE

Last Name

DOUGLAS

Suffix

DMD

Business Name

ROBERT DUANE DOUGLAS DMD

Original Issue Date

11/02/2006

Effective Date

10/17/2021

Expiration Date

09/30/2024

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025