GERUSA S MELLO-BURSTADT DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

NOT RENEWED

Business

First Name

GERUSA S

Last Name

MELLO-BURSTADT

Suffix

DDS

Business Name

GERUSA S MELLO-BURSTADT DDS

Original Issue Date

12/16/1996

Effective Date

06/13/2018

Expiration Date

01/31/2022

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022