GREGORY H TIETZER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

NOT RENEWED

Business

First Name

GREGORY

Middle

Last Name

TIETZER

Suffix

DDS

Business Name

GREGORY H TIETZER DDS

Original Issue Date

09/17/1984

Effective Date

10/01/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60625

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012