JEFFREY T BRUNSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****42

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

Last Name

BRUNSON

Business Name

JEFFREY T BRUNSON

Original Issue Date

08/14/1986

Effective Date

08/14/1986

Expiration Date

09/30/1994

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005