NICK D BISHOP 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

NICK

Middle

Last Name

BISHOP

Business Name

NICK D BISHOP

Original Issue Date

06/29/2015

Effective Date

06/29/2015

Expiration Date

09/30/2018

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018