DOUGLAS DALE KOCH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****99

License Status

NOT RENEWED

Business

First Name

DOUGLAS DALE

Last Name

KOCH

Suffix

DDS

Business Name

DOUGLAS DALE KOCH DDS

Original Issue Date

12/28/1984

Effective Date

12/28/1984

Expiration Date

09/30/1986

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005