CLYDE EMIL SHEPHERD JR Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

First Name

CLYDE EMIL

Last Name

SHEPHERD JR

Business Name

CLYDE EMIL SHEPHERD JR

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

ROCKFORD

State

Zip

61105

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005