JOHN WILLIAM DISTEL 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

JOHN

Middle

WILLIAM

Last Name

DISTEL

Suffix

DMD

Business Name

JOHN WILLIAM DISTEL DMD

Original Issue Date

08/07/1998

Effective Date

08/07/1998

Expiration Date

09/30/2000

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005