GORDON BALLANTIN CROUCH DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013334

License Status

INACTIVE

Business

First Name

GORDON BALLANTIN

Last Name

CROUCH

Suffix

DMD

Business Name

GORDON BALLANTIN CROUCH DMD

Original Issue Date

07/16/1968

Effective Date

07/16/1968

Expiration Date

09/30/1992

City

SIMSBURY

State

Zip

06070

County

CONNECTICUT

Ever Disciplined

LastModifiedDate

10/12/2005