THERESE H GUSTAFSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****49

License Status

NOT RENEWED

Business

First Name

THERESE H

Last Name

GUSTAFSON

Suffix

DDS

Business Name

THERESE H GUSTAFSON DDS

Original Issue Date

11/29/1990

Effective Date

11/29/1990

Expiration Date

09/30/2000

City

ALGONQUIN

State

Zip

60102

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005