LUIS J BRAVO DMD Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

CANCELLED

Business

First Name

LUIS

Middle

Last Name

BRAVO

Suffix

DMD

Business Name

LUIS J BRAVO DMD

Original Issue Date

10/26/1999

Effective Date

10/26/1999

Expiration Date

09/30/2002

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005