CHAUNCEY CROSS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

NOT RENEWED

Business

First Name

CHAUNCEY

Last Name

CROSS

Business Name

CHAUNCEY CROSS

Original Issue Date

01/01/1998

Effective Date

09/03/2015

Expiration Date

09/30/2018

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/31/2018