GINA MICHELE DOMM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****40

License Status

NOT RENEWED

Business

First Name

GINA

Middle

MICHELE

Last Name

DOMM

Business Name

GINA MICHELE DOMM

Original Issue Date

06/28/2011

Effective Date

06/28/2011

Expiration Date

09/30/2012

City

SAN ANTONIO

State

Zip

78245

County

TEXAS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012