JERRY ADIEL DOUGLAS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

First Name

JERRY ADIEL

Last Name

DOUGLAS

Suffix

DMD

Business Name

JERRY ADIEL DOUGLAS DMD

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

HARRISBURG

State

Zip

62946

County

SALINE

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/17/2005