FRED JEROME JAECKEL Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****34

License Status

NOT RENEWED

Business

First Name

FRED JEROME

Last Name

JAECKEL

Business Name

FRED JEROME JAECKEL

Original Issue Date

01/01/1998

Expiration Date

09/30/2006

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006