JACK CLARK FISHER JR DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

NOT RENEWED

Business

First Name

JACK

Middle

CLARK

Last Name

FISHER

Suffix

JR DMD

Business Name

JACK CLARK FISHER JR DMD

Original Issue Date

10/19/2020

Effective Date

10/22/2021

Expiration Date

09/30/2024

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025