MARTIN ORVILLE GUSTAFSON DDS - Dentist License in Illinois | # 137000151

MARTIN ORVILLE GUSTAFSON DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000151

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

01/01/1998

Effective Date

07/24/2006

Expiration Date

09/30/2009

State

IL

Specialty/Qualifier

Deep Sedation and General Anesthesia

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.