BRIAN GARY SMITH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****25

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

GARY

Last Name

SMITH

Business Name

BRIAN GARY SMITH

Original Issue Date

08/03/2018

Effective Date

08/03/2018

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60642

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022