GLENN JAMES RESIDE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

First Name

GLENN

Middle

JAMES

Last Name

RESIDE

Business Name

GLENN JAMES RESIDE

Original Issue Date

05/06/2002

Effective Date

05/06/2002

Expiration Date

09/30/2004

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005