GREGORY M DIETZ DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000873

License Status

ACTIVE

Business

First Name

GREGORY

Middle

Last Name

DIETZ

Suffix

DMD

Business Name

GREGORY M DIETZ DMD

Original Issue Date

08/27/2013

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

05/02/2024