BROCKTON R WILLEY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****43

License Status

NOT RENEWED

Business

Title

DDS

First Name

BROCKTON

Middle

Last Name

WILLEY

Business Name

BROCKTON R WILLEY DDS

Original Issue Date

08/04/2015

Effective Date

08/04/2015

Expiration Date

09/30/2018

City

DUNLAP

State

Zip

61525

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018