STACY LYNN SULLIVAN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

INACTIVE

Business

First Name

STACY

Middle

LYNN

Last Name

SULLIVAN

Suffix

DDS

Business Name

STACY LYNN SULLIVAN DDS

Original Issue Date

08/09/2012

Effective Date

07/22/2015

Expiration Date

09/30/2018

City

BIRMINGHAM

State

Zip

48009

County

MICHIGAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2018