THOMAS ROBERT BRODERICK 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

THOMAS ROBERT

Last Name

BRODERICK

Business Name

THOMAS ROBERT BRODERICK

Original Issue Date

06/13/1983

Effective Date

06/13/1983

Expiration Date

09/30/1984

City

CAHOKIA

State

Zip

62206

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005