AMIR DASTGHEIB HOSSEINI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

AMIR

Middle

DASTGHEIB

Last Name

HOSSEINI

Suffix

DDS

Business Name

AMIR DASTGHEIB HOSSEINI DDS

Original Issue Date

06/03/2004

Effective Date

06/03/2004

Expiration Date

09/30/2006

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006