GARY SCOTT NICKERSON Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

ACTIVE

Business

First Name

GARY SCOTT

Last Name

NICKERSON

Business Name

GARY SCOTT NICKERSON

Original Issue Date

12/21/1998

Effective Date

08/23/2024

Expiration Date

09/30/2027

City

MOKENA

State

Zip

60448

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/23/2024