KEITH L WILCOX DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****59

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

WILCOX

Suffix

DDS

Business Name

KEITH L WILCOX DDS

Original Issue Date

12/12/2006

Effective Date

09/11/2012

Expiration Date

09/30/2015

City

MT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

02/08/2016