KIM LAWRENCE BROKAW Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****41

License Status

ACTIVE

Business

First Name

KIM LAWRENCE

Last Name

BROKAW

Business Name

KIM LAWRENCE BROKAW

Original Issue Date

10/04/1983

Effective Date

09/13/2024

Expiration Date

09/30/2027

City

DIXON

State

Zip

61021

County

LEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/13/2024