TIMOTHY A BACSA DDS 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

TIMOTHY

Middle

Last Name

BACSA

Suffix

DDS

Business Name

TIMOTHY A BACSA DDS

Original Issue Date

09/02/2005

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHARLESTON

State

Zip

61920

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009