BLASE MICHAEL LEON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019010744

License Status

NOT RENEWED

Business

First Name

BLASE MICHAEL

Last Name

LEON

Business Name

BLASE MICHAEL LEON

Original Issue Date

08/16/1955

Effective Date

07/03/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/08/2016