EVAN JACKSON SHORT DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****36

License Status

ACTIVE

Business

Title

DDS

First Name

EVAN

Middle

JACKSON

Last Name

SHORT

Business Name

EVAN JACKSON SHORT DDS

Original Issue Date

12/28/2022

Effective Date

08/30/2024

Expiration Date

09/30/2027

City

BELVIDERE

State

Zip

61008

County

BOONE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

08/30/2024