THERESA KENNA MILLER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

THERESA

Middle

KENNA

Last Name

MILLER

Suffix

DMD

Business Name

THERESA KENNA MILLER DMD

Original Issue Date

05/30/2008

Effective Date

08/08/2012

Expiration Date

09/30/2015

City

VINE GROVE

State

Zip

40175

County

KENTUCKY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016