JEFFERY ROYCE BRUNSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

NOT RENEWED

Business

First Name

JEFFERY

Middle

ROYCE

Last Name

BRUNSON

Suffix

DDS

Business Name

JEFFERY ROYCE BRUNSON DDS

Original Issue Date

10/18/2000

Effective Date

10/18/2000

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005