BLASE MICHAEL LEON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****03

License Status

NOT RENEWED

Business

First Name

BLASE MICHAEL

Last Name

LEON

Business Name

BLASE MICHAEL LEON

Original Issue Date

01/01/1998

Expiration Date

09/30/1992

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/13/2005