SAMUEL R BRUNNER 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

SAMUEL R

Last Name

BRUNNER

Suffix

DDS

Business Name

SAMUEL R BRUNNER DDS

Original Issue Date

09/20/1995

Effective Date

09/20/1995

Expiration Date

09/30/1996

City

CHICAGO

State

Zip

60641

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005