KETU P LINCOLN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****60

License Status

NOT RENEWED

Business

First Name

KETU

Middle

Last Name

LINCOLN

Business Name

KETU P LINCOLN

Original Issue Date

12/31/2002

Effective Date

12/31/2002

Expiration Date

09/30/2004

City

SCOTT AFB

State

Zip

62225

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005