BRUCE JOHN DIETZ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019017435

License Status

NOT RENEWED

Business

First Name

BRUCE JOHN

Last Name

DIETZ

Suffix

DDS

Business Name

BRUCE JOHN DIETZ DDS

Original Issue Date

09/15/1980

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

11/08/2006