AMITY LEE GARDNER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****80

License Status

NOT RENEWED

Business

First Name

AMITY

Middle

LEE

Last Name

GARDNER

Suffix

DDS

Business Name

AMITY LEE GARDNER DDS

Original Issue Date

03/04/2002

Effective Date

03/04/2002

Expiration Date

09/30/2002

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005