SAMUEL R BRUNNER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

NOT RENEWED

Business

First Name

SAMUEL R

Last Name

BRUNNER

Suffix

DDS

Business Name

SAMUEL R BRUNNER DDS

Original Issue Date

02/02/1996

Effective Date

02/02/1996

Expiration Date

09/30/1996

City

MORTON

State

Zip

61550

County

TAZEWELL

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/13/2005