M CAMILLE FULLER DDS 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

Middle

CAMILLE

Last Name

FULLER

Suffix

DDS

Business Name

M CAMILLE FULLER DDS

Original Issue Date

06/15/1990

Effective Date

09/22/2009

Expiration Date

09/30/2012

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012