GAY WINIFRED BRODERSEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000482

License Status

NOT RENEWED

Business

First Name

GAY

Middle

WINIFRED

Last Name

BRODERSEN

Suffix

DDS

Business Name

GAY WINIFRED BRODERSEN DDS

Original Issue Date

10/22/1999

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

SCHAUMBURG

State

Zip

60195

County

COOK

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

11/04/2009