TINA MARIE BRENZA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000496

License Status

NOT RENEWED

Business

First Name

TINA

Middle

MARIE

Last Name

BRENZA

Suffix

DDS

Business Name

TINA MARIE BRENZA DDS

Original Issue Date

06/15/2000

Effective Date

08/28/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

02/08/2016