BRIAN R DE GISE DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****11

License Status

ACTIVE

Business

First Name

BRIAN

Middle

Last Name

DE GISE

Suffix

DDS

Business Name

BRIAN R DE GISE DDS

Original Issue Date

08/31/1989

Effective Date

05/01/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2024