ALLEN PRENDIVOJ DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

NOT RENEWED

Business

First Name

ALLEN

Last Name

PRENDIVOJ

Suffix

DMD

Business Name

ALLEN PRENDIVOJ DMD

Original Issue Date

10/22/1996

Effective Date

10/22/1996

Expiration Date

09/30/2000

City

BELLEVILLE

State

Zip

62223

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005