BRENT DOUGLAS MARTIN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****95

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

DOUGLAS

Last Name

MARTIN

Suffix

DMD

Business Name

BRENT DOUGLAS MARTIN DMD

Original Issue Date

08/06/2003

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009