ADAM TIMOTHY BIRK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

NOT RENEWED

Business

First Name

ADAM

Middle

TIMOTHY

Last Name

BIRK

Business Name

ADAM TIMOTHY BIRK

Original Issue Date

01/21/2015

Effective Date

01/21/2015

Expiration Date

09/30/2015

City

SAINT LOUIS

State

Zip

63123

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/12/2016