NATHAN MICHAEL ANTOINE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

First Name

NATHAN

Middle

MICHAEL

Last Name

ANTOINE

Business Name

NATHAN MICHAEL ANTOINE

Original Issue Date

06/25/2020

Effective Date

06/25/2020

Expiration Date

01/31/2022

City

OLIVETTE

State

Zip

63132

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022