GARY WILLIAM LONG DDS 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

GARY WILLIAM

Last Name

LONG

Suffix

DDS

Business Name

GARY WILLIAM LONG DDS

Original Issue Date

01/01/1998

Effective Date

10/15/2015

Expiration Date

09/30/2018

City

MORTON

State

Zip

61550

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018