GARY WAYNE GUSTAVSON DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015094

License Status

INACTIVE

Business

Title

DDS

First Name

GARY

Middle

WAYNE

Last Name

GUSTAVSON

Business Name

GARY WAYNE GUSTAVSON DDS

Original Issue Date

03/27/1975

Effective Date

10/01/2006

Expiration Date

09/30/2009

City

SKOKIE

State

Zip

60077

County

COOK

Ever Disciplined

LastModifiedDate

06/04/2009