CARLA R LEWIS-LONGLEY 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

CARLA R

Last Name

LEWIS-LONGLEY

Business Name

CARLA R LEWIS-LONGLEY

Original Issue Date

09/27/1988

Effective Date

10/01/2018

Expiration Date

01/31/2022

City

EAST SAINT LOUIS

State

Zip

62205

County

SAINT CLAIR

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/09/2022