BRYAN M GOLDESBERRY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****43

License Status

NOT RENEWED

Business

First Name

BRYAN

Middle

Last Name

GOLDESBERRY

Business Name

BRYAN M GOLDESBERRY

Original Issue Date

05/11/2011

Effective Date

05/11/2011

Expiration Date

09/30/2012

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/14/2012