DIANE M BRANDLEIN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****04

License Status

NOT RENEWED

Business

First Name

DIANE M

Last Name

BRANDLEIN

Business Name

DIANE M BRANDLEIN

Original Issue Date

03/18/1985

Effective Date

03/18/1985

Expiration Date

09/30/1986

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005