JORDAN MICHAEL ELLIS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

ACTIVE

Business

First Name

JORDAN

Middle

MICHAEL

Last Name

ELLIS

Business Name

JORDAN MICHAEL ELLIS

Original Issue Date

08/13/2018

Effective Date

08/17/2024

Expiration Date

09/30/2027

City

FORSYTH

State

Zip

62535

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/17/2024