BRIAN D SHIN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

SHIN

Suffix

DDS

Business Name

BRIAN D SHIN DDS

Original Issue Date

08/11/2006

Effective Date

08/11/2006

Expiration Date

09/30/2009

City

GRANITE CITY

State

Zip

62040

County

MADISON

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009