MARTIN ORVILLE GUSTAFSON DDS - Dentist License in Illinois | # 019012622

MARTIN ORVILLE GUSTAFSON DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019012622

License Status

NOT RENEWED

Business

N

First Name

MARTIN

Middle

ORVILLE

Last Name

GUSTAFSON

Suffix

DDS

Business Name

MARTIN ORVILLE GUSTAFSON DDS

Original Issue Date

11/25/1964

Effective Date

10/01/2006

Expiration Date

09/30/2009

State

IL

Ever Disciplined

Y

LastModifiedDate

11/04/2009

Case Number

2009006419

Action

Refuse To Renew

Discipline Start Date

08/27/2009

Discipline Reason

for failure to respond to a continuing education audit.