LARRY RAY MITTENDORF DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****31

License Status

NOT RENEWED

Business

First Name

LARRY RAY

Last Name

MITTENDORF

Suffix

DDS

Business Name

LARRY RAY MITTENDORF DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1988

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005