JENNIFER K BRUBAKER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

NOT RENEWED

Business

Title

DMD

First Name

JENNIFER

Middle

Last Name

BRUBAKER

Business Name

JENNIFER K BRUBAKER DMD

Original Issue Date

06/30/2006

Effective Date

06/30/2009

Expiration Date

09/30/2012

City

GRANITE CITY

State

Zip

62040

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012