RICHARD T MOON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****46

License Status

NOT RENEWED

Business

First Name

RICHARD T

Last Name

MOON

Business Name

RICHARD T MOON

Original Issue Date

02/25/2022

Effective Date

02/25/2022

Expiration Date

09/30/2024

City

TRIVOLI

State

Zip

61569

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025