JASON F FOREMAN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****30

License Status

INACTIVE

Business

First Name

JASON

Middle

Last Name

FOREMAN

Suffix

DDS

Business Name

JASON F FOREMAN DDS

Original Issue Date

12/11/2013

Effective Date

08/16/2018

Expiration Date

12/31/2021

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/16/2021