AUSTIN JEFFREY DEPORTER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

NOT RENEWED

Business

Title

DMD

First Name

AUSTIN

Middle

JEFFREY

Last Name

DEPORTER

Business Name

AUSTIN JEFFREY DEPORTER DMD

Original Issue Date

09/25/2013

Effective Date

08/20/2015

Expiration Date

09/30/2018

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018