BRIAN LEE KLOBERDANZ 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

BRIAN LEE

Last Name

KLOBERDANZ

Business Name

BRIAN LEE KLOBERDANZ

Original Issue Date

04/23/1993

Effective Date

04/23/1993

Expiration Date

09/30/2006

City

SANDWICH

State

Zip

60548

County

DEKALB

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006