AZARYAS TADIWOS MANDEFRO DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019028572

License Status

NOT RENEWED

Business

First Name

AZARYAS

Middle

TADIWOS

Last Name

MANDEFRO

Suffix

DMD

Business Name

AZARYAS TADIWOS MANDEFRO DMD

Original Issue Date

04/01/2011

Effective Date

04/01/2011

Expiration Date

09/30/2012

City

SAINT PETERS

State

Zip

63376

County

MISSOURI

Ever Disciplined

LastModifiedDate

11/14/2012