BARRY L BERGMAN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****21

License Status

NOT RENEWED

Business

First Name

BARRY L

Last Name

BERGMAN

Suffix

DDS

Business Name

BARRY L BERGMAN DDS

Original Issue Date

01/01/1998

Effective Date

08/26/2009

Expiration Date

09/30/2012

City

BLOOMINGTON

State

Zip

61702

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012