BRINDHA K SUBRAMANIAN Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****04

License Status

CANCELLED

Business

First Name

BRINDHA

Middle

Last Name

SUBRAMANIAN

Business Name

BRINDHA K SUBRAMANIAN

Original Issue Date

10/24/2007

Effective Date

10/24/2007

Expiration Date

09/30/2009

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/04/2009