TODD ALLEN JOHNSON 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

TODD

Middle

ALLEN

Last Name

JOHNSON

Business Name

TODD ALLEN JOHNSON

Original Issue Date

09/14/2009

Effective Date

08/13/2015

Expiration Date

09/30/2018

City

GRANITE CITY

State

Zip

62040

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018