PHILIP RAY TRAVIS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****89

License Status

NOT RENEWED

Business

First Name

PHILIP

Middle

RAY

Last Name

TRAVIS

Suffix

DMD

Business Name

PHILIP RAY TRAVIS DMD

Original Issue Date

04/07/2009

Effective Date

04/07/2009

Expiration Date

09/30/2009

City

SPRINGFIELD

State

Zip

67202

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009