JOHN AUSTIN MOODY DDS 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

JOHN AUSTIN

Last Name

MOODY

Suffix

DDS

Business Name

JOHN AUSTIN MOODY DDS

Original Issue Date

11/17/1995

Effective Date

11/17/1995

Expiration Date

09/30/2002

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005