BASIL W REMLEY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

NOT RENEWED

Business

First Name

BASIL W

Last Name

REMLEY

Business Name

BASIL W REMLEY

Original Issue Date

04/21/1988

Effective Date

04/21/1988

Expiration Date

09/30/1992

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/13/2005