GREGORY GRANT OLSEN - Dentist License in Illinois | # 018001609

GREGORY GRANT OLSEN

Business Entity

CANCELLED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001609

License Status

CANCELLED

Business

N

First Name

GREGORY

Middle

GRANT

Last Name

OLSEN

Business Name

GREGORY GRANT OLSEN

Original Issue Date

08/28/2006

Effective Date

08/28/2006

Expiration Date

06/30/2010

State

IL

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

N

LastModifiedDate

06/23/2006