BRIAN J BOLLAERT Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****31

License Status

NOT RENEWED

Business

First Name

BRIAN J

Last Name

BOLLAERT

Business Name

BRIAN J BOLLAERT

Original Issue Date

08/04/1982

Effective Date

09/11/2012

Expiration Date

09/30/2015

City

EAST MOLINE

State

Zip

61244

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016