WILLIAM MANSFIELD MARTIN 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

WILLIAM

Middle

MANSFIELD

Last Name

MARTIN

Business Name

WILLIAM MANSFIELD MARTIN

Original Issue Date

03/04/1999

Effective Date

07/10/2007

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