GERALD ROBERT BLAKE DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****12

License Status

CANCELLED

Business

First Name

GERALD

Middle

ROBERT

Last Name

BLAKE

Suffix

DDS

Business Name

GERALD ROBERT BLAKE DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2006

City

SAINT CHARLES

State

Zip

60175

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006