BRENT ALLEN DANIELSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015421

License Status

NOT RENEWED

Business

First Name

BRENT ALLEN

Last Name

DANIELSON

Suffix

DDS

Business Name

BRENT ALLEN DANIELSON DDS

Original Issue Date

03/02/1976

Effective Date

09/27/2012

Expiration Date

09/30/2015

City

LAGRANGE

State

Zip

60525

County

COOK

Ever Disciplined

LastModifiedDate

02/08/2016