GERALD ROBERT BLAKE DDS - Dentist License in Illinois | # 019011459

GERALD ROBERT BLAKE DDS

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019011459

License Status

INACTIVE

Business

N

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

State

IL

Ever Disciplined

N

LastModifiedDate

07/24/2006