GLENN JAMES RESIDE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000570

License Status

NOT RENEWED

Business

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

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

10/17/2005