TANNER MICHAEL BROWN 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

TANNER

Middle

MICHAEL

Last Name

BROWN

Business Name

TANNER MICHAEL BROWN

Original Issue Date

08/12/2019

Effective Date

08/12/2019

Expiration Date

01/31/2022

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022