JACK EDWARD JORDAN DMD 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

JACK EDWARD

Last Name

JORDAN

Suffix

DMD

Business Name

JACK EDWARD JORDAN DMD

Original Issue Date

01/01/1998

Expiration Date

09/30/1998

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005