MARTIN ORVILLE GUSTAFSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000151

License Status

NOT RENEWED

Business

First Name

MARTIN

Middle

ORVILLE

Last Name

GUSTAFSON

Suffix

DDS

Business Name

MARTIN ORVILLE GUSTAFSON DDS

Original Issue Date

01/01/1998

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

GENEVA

State

Zip

60134

County

KANE

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

11/04/2009

Case Number

2009006419

Action

Refuse To Renew

Discipline Start Date

08/27/2009

Discipline Reason

for failure to respond to a continuing education audit.