JASON L ALLEN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****55

License Status

NOT RENEWED

Business

First Name

JASON

Middle

Last Name

ALLEN

Suffix

DMD

Business Name

JASON L ALLEN DMD

Original Issue Date

06/01/2004

Effective Date

06/01/2004

Expiration Date

09/30/2006

City

COLUMBIA

State

Zip

62236

County

MONROE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006