KEITH E BUGGS 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

KEITH E

Last Name

BUGGS

Business Name

KEITH E BUGGS

Original Issue Date

06/14/1989

Effective Date

06/14/1989

Expiration Date

09/30/1992

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005