J BARRY TILLIS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****82

License Status

ACTIVE

Business

First Name

Middle

BARRY

Last Name

TILLIS

Business Name

J BARRY TILLIS

Original Issue Date

08/14/1986

Effective Date

08/19/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/19/2024