EDWARD R LONG - Dentist License in Illinois | # 019025972

EDWARD R LONG

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019025972

License Status

NOT RENEWED

Business

N

First Name

EDWARD

Middle

R

Last Name

LONG

Business Name

EDWARD R LONG

Original Issue Date

09/18/2002

Effective Date

09/30/2004

Expiration Date

09/30/2006

State

IL

Ever Disciplined

N

LastModifiedDate

11/08/2006