TALYA T MINTZ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

First Name

TALYA

Middle

Last Name

MINTZ

Suffix

DDS

Business Name

TALYA T MINTZ DDS

Original Issue Date

08/05/2004

Effective Date

12/01/2009

Expiration Date

09/30/2012

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012