PHILIP BRIAN LEEDS DMD MD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****40

License Status

NOT RENEWED

Business

First Name

PHILIP BRIAN

Last Name

LEEDS

Suffix

DMD MD

Business Name

PHILIP BRIAN LEEDS DMD MD

Original Issue Date

01/01/1998

Effective Date

08/28/2012

Expiration Date

09/30/2015

City

MOUNT CARMEL

State

Zip

62863

County

WABASH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016

Case Number

1982000060

Action

Suspension

Discipline Start Date

01/19/1984

Discipline End Date

09/13/1985