ROBERT GLENN SHALES Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

CANCELLED

Business

First Name

ROBERT GLENN

Last Name

SHALES

Business Name

ROBERT GLENN SHALES

Original Issue Date

01/01/1998

Expiration Date

09/30/1992

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

III IV

Ever Disciplined

LastModifiedDate

10/13/2005