FERNANDO R BRICENO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000983

License Status

NOT RENEWED

Business

First Name

FERNANDO

Middle

Last Name

BRICENO

Business Name

FERNANDO R BRICENO

Original Issue Date

09/18/1996

Effective Date

09/18/1996

Expiration Date

06/30/1997

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

LastModifiedDate

10/12/2005