CHARLES W MATTY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****47

License Status

NOT RENEWED

Business

First Name

CHARLES W

Last Name

MATTY

Business Name

CHARLES W MATTY

Original Issue Date

01/01/1998

Effective Date

08/19/2009

Expiration Date

09/30/2012

City

ROCKFORD

State

Zip

61112

County

WINNEBAGO

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

11/14/2012