THOMAS W FONNER DMD 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

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

09/30/2006

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006