ADAM TIMOTHY BIRK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****94

License Status

NOT RENEWED

Business

First Name

ADAM

Middle

TIMOTHY

Last Name

BIRK

Business Name

ADAM TIMOTHY BIRK

Original Issue Date

06/17/2014

Effective Date

06/17/2014

Expiration Date

09/30/2015

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016