KELLY R MONTGOMERY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

NOT RENEWED

Business

First Name

KELLY R

Last Name

MONTGOMERY

Suffix

DDS

Business Name

KELLY R MONTGOMERY DDS

Original Issue Date

01/21/1994

Effective Date

01/21/1994

Expiration Date

09/30/1996

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005