GAY WINIFRED BRODERSEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000707

License Status

NOT RENEWED

Business

First Name

GAY

Middle

WINIFRED

Last Name

BRODERSEN

Suffix

DDS

Business Name

GAY WINIFRED BRODERSEN DDS

Original Issue Date

06/29/1993

Effective Date

06/29/1993

Expiration Date

06/30/1995

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatric Dentist

Ever Disciplined

LastModifiedDate

07/30/2018