THOMAS JAY HEIDENREICH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****55

License Status

NOT RENEWED

Business

Title

DDS

First Name

THOMAS

Middle

JAY

Last Name

HEIDENREICH

Business Name

THOMAS JAY HEIDENREICH DDS

Original Issue Date

12/21/2017

Effective Date

06/15/2018

Expiration Date

01/31/2022

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022