DANIEL DAVID HISEROTE JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

NOT RENEWED

Business

Title

DDS

First Name

DANIEL

Middle

DAVID

Last Name

HISEROTE

Suffix

Business Name

DANIEL DAVID HISEROTE JR DDS

Original Issue Date

07/18/2013

Effective Date

07/18/2013

Expiration Date

09/30/2015

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016