GEHAN M ADAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

License Status

NOT RENEWED

Business

First Name

GEHAN

Middle

Last Name

ADAM

Business Name

GEHAN M ADAM

Original Issue Date

08/03/2006

Effective Date

08/03/2006

Expiration Date

09/30/2009

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009