ANDY J MALCOLM DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****62

License Status

ACTIVE

Business

First Name

ANDY

Middle

Last Name

MALCOLM

Suffix

DDS

Business Name

ANDY J MALCOLM DDS

Original Issue Date

12/26/2007

Effective Date

05/06/2024

Expiration Date

09/30/2027

City

BELVIDERE

State

Zip

61008

County

BOONE

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/06/2024