GERALD R THEBERGE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****11

License Status

NOT RENEWED

Business

First Name

GERALD R

Last Name

THEBERGE

Suffix

DDS

Business Name

GERALD R THEBERGE DDS

Original Issue Date

09/02/1981

Effective Date

09/02/1981

Expiration Date

06/01/1982

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005