JEFFREY MICHAEL DOUGHERTY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****52

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

MICHAEL

Last Name

DOUGHERTY

Business Name

JEFFREY MICHAEL DOUGHERTY

Original Issue Date

06/25/2002

Effective Date

06/25/2002

Expiration Date

09/30/2004

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005