BRIAN R DE GISE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

DE GISE

Suffix

DDS

Business Name

BRIAN R DE GISE DDS

Original Issue Date

08/23/1996

Effective Date

08/23/1996

Expiration Date

09/30/2000

City

CANTON

State

Zip

61520

County

FULTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005