KENNETH MICHAEL FASIG 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

KENNETH MICHAEL

Last Name

FASIG

Business Name

KENNETH MICHAEL FASIG

Original Issue Date

02/20/1986

Effective Date

02/20/1986

Expiration Date

09/30/1992

City

PEKIN

State

Zip

61554

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005