KEITH ALLEN EVANS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****82

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

ALLEN

Last Name

EVANS

Suffix

DMD

Business Name

KEITH ALLEN EVANS DMD

Original Issue Date

11/13/2014

Effective Date

08/18/2015

Expiration Date

09/30/2018

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018