J DAEDALUS MOON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

NOT RENEWED

Business

First Name

J DAEDALUS

Last Name

MOON

Business Name

J DAEDALUS MOON

Original Issue Date

12/10/1986

Effective Date

12/10/1986

Expiration Date

09/30/1990

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005