THOMAS W FONNER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

FONNER

Suffix

DMD

Business Name

THOMAS W FONNER DMD

Original Issue Date

10/25/2002

Effective Date

10/25/2002

Expiration Date

09/30/2004

City

MARYVILLE

State

Zip

62062

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005