DEBRA K JACKSON MD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****50

License Status

NOT RENEWED

Business

Title

First Name

DEBRA K

Last Name

JACKSON

Business Name

DEBRA K JACKSON MD

Original Issue Date

07/20/1992

Effective Date

07/20/1992

Expiration Date

09/30/1994

City

CHAMPAIGN

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005