CONSTANCE BAKER PHILLIPS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

NOT RENEWED

Business

First Name

CONSTANCE BAKER

Last Name

PHILLIPS

Business Name

CONSTANCE BAKER PHILLIPS

Original Issue Date

07/09/1981

Effective Date

07/09/1981

Expiration Date

09/30/1984

City

GODFREY

State

Zip

62035

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005