MARTIN ORVILLE GUSTAFSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019012622

License Status

NOT RENEWED

Business

First Name

MARTIN

Middle

ORVILLE

Last Name

GUSTAFSON

Suffix

DDS

Business Name

MARTIN ORVILLE GUSTAFSON DDS

Original Issue Date

11/25/1964

Effective Date

10/01/2006

Expiration Date

09/30/2009

City

GENEVA

State

Zip

60134

County

KANE

Ever Disciplined

LastModifiedDate

11/04/2009

Case Number

2009006419

Action

Refuse To Renew

Discipline Start Date

08/27/2009

Discipline Reason

for failure to respond to a continuing education audit.