KENNETH ROBERT BROCKER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****53

License Status

NOT RENEWED

Business

First Name

KENNETH ROBERT

Last Name

BROCKER

Suffix

DDS

Business Name

KENNETH ROBERT BROCKER DDS

Original Issue Date

08/01/1991

Effective Date

08/01/1991

Expiration Date

09/30/1992

City

CHICAGO

State

Zip

60634

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005