TIMOTHY D SUPAN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****63

License Status

ACTIVE

Business

First Name

TIMOTHY D

Last Name

SUPAN

Suffix

DMD

Business Name

TIMOTHY D SUPAN DMD

Original Issue Date

08/23/1995

Effective Date

09/23/2024

Expiration Date

09/30/2027

City

GRIDLEY

State

Zip

61744

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/23/2024