BROCK W GARDNER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019031653

License Status

NOT RENEWED

Business

Title

DMD

First Name

BROCK

Middle

Last Name

GARDNER

Business Name

BROCK W GARDNER DMD

Original Issue Date

06/05/2018

Effective Date

12/09/2021

Expiration Date

09/30/2024

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

02/04/2025