STEPHANIE ELAINE GRAHAM DMD 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

STEPHANIE ELAINE

Last Name

GRAHAM

Suffix

DMD

Business Name

STEPHANIE ELAINE GRAHAM DMD

Original Issue Date

08/20/1997

Effective Date

08/20/1997

Expiration Date

09/30/2000

City

GILLESPIE

State

Zip

62033

County

MACOUPIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005