LARRY W CROCKER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

LARRY W

Last Name

CROCKER

Business Name

LARRY W CROCKER

Original Issue Date

09/08/1987

Effective Date

08/20/2009

Expiration Date

09/30/2012

City

GODFREY

State

Zip

62035

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012