GLEN J PICHICHERO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****50

License Status

NOT RENEWED

Business

First Name

GLEN J

Last Name

PICHICHERO

Business Name

GLEN J PICHICHERO

Original Issue Date

12/13/1984

Effective Date

12/13/1984

Expiration Date

09/30/1986

City

TAMMS

State

Zip

62988

County

ALEXANDER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005