STEPHEN PIERCE FORSYTH DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****65

License Status

CANCELLED

Business

First Name

STEPHEN

Middle

PIERCE

Last Name

FORSYTH

Suffix

DMD

Business Name

STEPHEN PIERCE FORSYTH DMD

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005