JACK IAN MAYER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****33

License Status

NOT RENEWED

Business

First Name

JACK

Middle

IAN

Last Name

MAYER

Suffix

DMD

Business Name

JACK IAN MAYER DMD

Original Issue Date

06/25/1998

Effective Date

06/25/1998

Expiration Date

09/30/2000

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005