MYLES JORDAN HASTINGS 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

MYLES

Middle

JORDAN

Last Name

HASTINGS

Business Name

MYLES JORDAN HASTINGS

Original Issue Date

08/13/2018

Effective Date

08/13/2018

Expiration Date

01/31/2022

City

SHELBYVILLE

State

Zip

62565

County

SHELBY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022