MOODY M WASIF DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****83

License Status

NOT RENEWED

Business

Title

DMD

First Name

MOODY

Middle

Last Name

WASIF

Business Name

MOODY M WASIF DMD

Original Issue Date

12/29/2010

Effective Date

12/02/2014

Expiration Date

09/30/2015

City

CROWN POINT

State

Zip

46307

County

INDIANA

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

02/08/2016