DEREK TYRONE TILLMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****51

License Status

NOT RENEWED

Business

First Name

DEREK

Middle

TYRONE

Last Name

TILLMAN

Business Name

DEREK TYRONE TILLMAN

Original Issue Date

07/09/2007

Effective Date

09/04/2012

Expiration Date

09/30/2015

City

BELLAIRE

State

Zip

77401

County

TEXAS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016