THOMAS JAY HEIDENREICH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****48

License Status

NOT RENEWED

Business

Title

DDS

First Name

THOMAS

Middle

JAY

Last Name

HEIDENREICH

Business Name

THOMAS JAY HEIDENREICH DDS

Original Issue Date

03/18/2020

Effective Date

03/18/2020

Expiration Date

01/31/2022

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022