SVEN SUPPLIES DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

NOT RENEWED

Business

First Name

SVEN

Last Name

SUPPLIES

Suffix

DMD

Business Name

SVEN SUPPLIES DMD

Original Issue Date

12/09/1997

Effective Date

12/09/1997

Expiration Date

09/30/2000

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005