NATHAN LONG DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019017543

License Status

NOT RENEWED

Business

First Name

NATHAN

Last Name

LONG

Suffix

DDS

Business Name

NATHAN LONG DDS

Original Issue Date

03/19/1981

Effective Date

11/16/2009

Expiration Date

09/30/2012

City

CRETE

State

Zip

60417

County

WILL

Ever Disciplined

LastModifiedDate

11/14/2012

Case Number

2005006676

Action

Suspension

Discipline Start Date

06/15/2012

Discipline Reason

for failure to pass JERM examination.