GERALD ROBERT BLAKE DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019011459

License Status

INACTIVE

Business

First Name

GERALD

Middle

ROBERT

Last Name

BLAKE

Suffix

DDS

Business Name

GERALD ROBERT BLAKE DDS

Original Issue Date

08/04/1959

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

SAINT CHARLES

State

Zip

60175

County

KANE

Ever Disciplined

LastModifiedDate

07/24/2006