LEE C VANDEWATER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****42

License Status

NOT RENEWED

Business

First Name

LEE C

Last Name

VANDEWATER

Suffix

DMD

Business Name

LEE C VANDEWATER DMD

Original Issue Date

07/23/1992

Effective Date

07/23/1992

Expiration Date

09/30/1994

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005