BLASE P BROWN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

NOT RENEWED

Business

First Name

BLASE P

Last Name

BROWN

Suffix

DDS

Business Name

BLASE P BROWN DDS

Original Issue Date

01/09/1992

Effective Date

01/09/1992

Expiration Date

09/30/1992

City

CHICAGO

State

Zip

60629

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005