AMY M WYATT DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****74

License Status

NOT RENEWED

Business

Title

DMD

First Name

AMY

Middle

Last Name

WYATT

Business Name

AMY M WYATT DMD

Original Issue Date

09/18/2006

Effective Date

09/18/2006

Expiration Date

09/30/2009

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009