ERIC SCOTT BROCKMAN DMD - Dentist License in Wisconsin | # 31*****12

ERIC SCOTT BROCKMAN DMD

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****12

License Status

NOT RENEWED

Business

N

Title

DMD

First Name

ERIC

Middle

SCOTT

Last Name

BROCKMAN

Business Name

ERIC SCOTT BROCKMAN DMD

Original Issue Date

09/21/2021

Effective Date

09/21/2021

Expiration Date

09/30/2024

State

WI

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

02/04/2025