PHILLIP M JENSEN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****62

License Status

NOT RENEWED

Business

First Name

PHILLIP

Middle

Last Name

JENSEN

Suffix

DMD

Business Name

PHILLIP M JENSEN DMD

Original Issue Date

05/11/2001

Effective Date

06/04/2009

Expiration Date

09/30/2012

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012