ROBIN BRENT BLAKKOLB DDS - Dentist License in Illinois | # 137000139

ROBIN BRENT BLAKKOLB DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000139

License Status

NOT RENEWED

Business

N

First Name

ROBIN BRENT

Last Name

BLAKKOLB

Suffix

DDS

Business Name

ROBIN BRENT BLAKKOLB DDS

Original Issue Date

01/01/1998

Effective Date

08/16/2018

Expiration Date

01/31/2022

State

IL

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

N

LastModifiedDate

05/09/2022