JILLIAN MARIE BRUCH DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

NOT RENEWED

Business

Title

DMD

First Name

JILLIAN

Middle

MARIE

Last Name

BRUCH

Business Name

JILLIAN MARIE BRUCH DMD

Original Issue Date

06/10/2015

Effective Date

06/10/2015

Expiration Date

09/30/2018

City

GLEN CARBON

State

Zip

62034

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018