RENJU ALEX THACKENKARY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

NOT RENEWED

Business

Title

DDS

First Name

RENJU

Middle

ALEX

Last Name

THACKENKARY

Business Name

RENJU ALEX THACKENKARY DDS

Original Issue Date

06/28/2010

Effective Date

06/27/2012

Expiration Date

09/30/2015

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016