PHILIP S VALICOFF 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

PHILIP S

Last Name

VALICOFF

Business Name

PHILIP S VALICOFF

Original Issue Date

12/05/1986

Effective Date

08/08/2018

Expiration Date

01/31/2022

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022