THOMAS W FONNER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

FONNER

Suffix

DMD

Business Name

THOMAS W FONNER DMD

Original Issue Date

02/11/1999

Effective Date

02/11/1999

Expiration Date

09/30/2002

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005