ANTHONY M SPINA DDS MD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

NOT RENEWED

Business

Title

First Name

ANTHONY M

Last Name

SPINA

Suffix

DDS

Business Name

ANTHONY M SPINA DDS MD

Original Issue Date

08/31/2012

Effective Date

08/31/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016