THOMAS W FONNER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****90

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

FONNER

Suffix

DMD

Business Name

THOMAS W FONNER DMD

Original Issue Date

04/08/2005

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009