SAM EDWARD FARISH DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000011

License Status

NOT RENEWED

Business

First Name

SAM EDWARD

Last Name

FARISH

Suffix

DMD

Business Name

SAM EDWARD FARISH DMD

Original Issue Date

01/03/1991

Effective Date

01/03/1991

Expiration Date

01/02/1993

City

BALLWIN

State

Zip

63011

County

MISSOURI

Ever Disciplined

LastModifiedDate

10/13/2005