JONATHON C PARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

First Name

JONATHON

Middle

Last Name

PARK

Suffix

DDS

Business Name

JONATHON C PARK DDS

Original Issue Date

02/21/2012

Effective Date

07/17/2012

Expiration Date

09/30/2015

City

BELVIDERE

State

Zip

61008

County

BOONE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016