GLENN JAMES RESIDE - Dentist License in Illinois | # 137000570

GLENN JAMES RESIDE

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000570

License Status

NOT RENEWED

Business

N

First Name

GLENN

Middle

JAMES

Last Name

RESIDE

Business Name

GLENN JAMES RESIDE

Original Issue Date

09/30/2002

Effective Date

09/30/2002

Expiration Date

09/30/2004

State

IL

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

N

LastModifiedDate

10/17/2005