GAY WINIFRED BRODERSEN DDS - Dentist License in Illinois | # 018000707

GAY WINIFRED BRODERSEN DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000707

License Status

NOT RENEWED

Business

N

First Name

GAY

Middle

WINIFRED

Last Name

BRODERSEN

Suffix

DDS

Business Name

GAY WINIFRED BRODERSEN DDS

Original Issue Date

06/29/1993

Effective Date

06/29/1993

Expiration Date

06/30/1995

State

IL

Specialty/Qualifier

Pediatric Dentist

Ever Disciplined

N

LastModifiedDate

07/30/2018