WACLAW MARION BRYLAK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****28

License Status

NOT RENEWED

Business

First Name

WACLAW MARION

Last Name

BRYLAK

Suffix

DDS

Business Name

WACLAW MARION BRYLAK DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2000

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005