MATT ADAM MLSNA 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

MATT ADAM

Last Name

MLSNA

Business Name

MATT ADAM MLSNA

Original Issue Date

10/22/1985

Effective Date

09/28/2021

Expiration Date

09/30/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025