ALEXANDER THADDEUS STANLEY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****30

License Status

NOT RENEWED

Business

First Name

ALEXANDER

Middle

THADDEUS

Last Name

STANLEY

Business Name

ALEXANDER THADDEUS STANLEY

Original Issue Date

09/04/2018

Effective Date

11/21/2021

Expiration Date

09/30/2024

City

VANDALIA

State

Zip

62471

County

FAYETTE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025