MICHAEL GENE CORREALE DMD Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

INOPERATIVE

Business

First Name

MICHAEL GENE

Last Name

CORREALE

Suffix

DMD

Business Name

MICHAEL GENE CORREALE DMD

Original Issue Date

09/05/1997

Effective Date

09/05/1997

Expiration Date

09/30/2000

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005