OTTO F TIDWELL DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019019526

License Status

NOT RENEWED

Business

First Name

OTTO

Middle

Last Name

TIDWELL

Suffix

DDS

Business Name

OTTO F TIDWELL DDS

Original Issue Date

05/14/1985

Effective Date

05/14/1985

Expiration Date

09/30/1988

City

PHILADELPHIA

State

Zip

19119

Ever Disciplined

LastModifiedDate

10/12/2005