MICHAEL PATRICK GORMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****07

License Status

NOT RENEWED

Business

First Name

MICHAEL PATRICK

Last Name

GORMAN

Business Name

MICHAEL PATRICK GORMAN

Original Issue Date

08/16/1983

Effective Date

08/16/1983

Expiration Date

09/30/1996

City

MANTENO

State

Zip

60950

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005