BRYAN FORREST PACKARD DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****25

License Status

NOT RENEWED

Business

Title

DMD

First Name

BRYAN

Middle

FORREST

Last Name

PACKARD

Business Name

BRYAN FORREST PACKARD DMD

Original Issue Date

07/16/2015

Effective Date

07/16/2015

Expiration Date

09/30/2018

City

LOUISVILLE

State

Zip

40245

County

KENTUCKY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018