ROBERT L BLACKWELL Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****94

License Status

ACTIVE

Business

First Name

ROBERT L

Last Name

BLACKWELL

Business Name

ROBERT L BLACKWELL

Original Issue Date

08/23/1983

Effective Date

05/13/2024

Expiration Date

09/30/2027

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/13/2024