BLAKE ANTHONY FERANDO DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019030670

License Status

NOT RENEWED

Business

Title

DMD

First Name

BLAKE

Middle

ANTHONY

Last Name

FERANDO

Business Name

BLAKE ANTHONY FERANDO DMD

Original Issue Date

06/07/2016

Effective Date

06/07/2016

Expiration Date

09/30/2018

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

10/31/2018