BRIAN ANTHONY PRUDENT DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

ACTIVE

Business

First Name

BRIAN

Middle

ANTHONY

Last Name

PRUDENT

Suffix

DMD

Business Name

BRIAN ANTHONY PRUDENT DMD

Original Issue Date

08/20/2001

Effective Date

05/01/2024

Expiration Date

09/30/2027

City

MOLINE

State

Zip

61265

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2024