GENE JOSEPH BLAKE JR DDS - Dentist License in Illinois | # 019015474

GENE JOSEPH BLAKE JR DDS

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015474

License Status

INACTIVE

Business

N

Title

DDS

First Name

GENE

Middle

JOSEPH

Last Name

BLAKE

Suffix

JR

Business Name

GENE JOSEPH BLAKE JR DDS

Original Issue Date

07/13/1976

Effective Date

08/14/2009

Expiration Date

09/30/2012

State

IL

Ever Disciplined

N

LastModifiedDate

06/06/2012