BRIAN C BACK DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****03

License Status

ACTIVE

Business

First Name

BRIAN

Middle

Last Name

BACK

Suffix

DMD

Business Name

BRIAN C BACK DMD

Original Issue Date

10/20/2008

Effective Date

06/17/2024

Expiration Date

09/30/2027

City

MILLSTADT

State

Zip

62260

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/17/2024