DOUGLAS DALE KOCH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****98

License Status

NOT RENEWED

Business

First Name

DOUGLAS DALE

Last Name

KOCH

Suffix

DDS

Business Name

DOUGLAS DALE KOCH DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1990

City

GODFREY

State

Zip

62035

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005