JON K DIVELY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****81

License Status

NOT RENEWED

Business

First Name

JON

Middle

Last Name

DIVELY

Suffix

DDS

Business Name

JON K DIVELY DDS

Original Issue Date

01/01/1998

Effective Date

06/07/2018

Expiration Date

01/31/2022

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022