EVELYN TEAGUE SAMUEL DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****36

License Status

NOT RENEWED

Business

Title

DMD

First Name

EVELYN

Middle

TEAGUE

Last Name

SAMUEL

Business Name

EVELYN TEAGUE SAMUEL DMD

Original Issue Date

12/19/2013

Effective Date

12/19/2013

Expiration Date

09/30/2015

City

BELLEVILLE

State

Zip

62223

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016