PAUL T MATLOCK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

PAUL T

Last Name

MATLOCK

Business Name

PAUL T MATLOCK

Original Issue Date

08/30/1995

Effective Date

08/30/1995

Expiration Date

09/30/1998

City

RED BUD

State

Zip

62278

County

MONROE

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/13/2005