BRANDON KEITH PETERSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

First Name

BRANDON

Middle

KEITH

Last Name

PETERSON

Business Name

BRANDON KEITH PETERSON

Original Issue Date

12/04/2007

Effective Date

12/04/2007

Expiration Date

09/30/2009

City

ROUND LAKE BEACH

State

Zip

60073

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV

Ever Disciplined

LastModifiedDate

11/04/2009