GARY EDWARD BURG 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

GARY

Middle

EDWARD

Last Name

BURG

Business Name

GARY EDWARD BURG

Original Issue Date

01/01/1998

Effective Date

06/04/2009

Expiration Date

09/30/2012

City

DIXON

State

Zip

61021

County

LEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012