EDDIE KIYOSHI BROTKOWSKI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

Title

DDS

First Name

EDDIE

Middle

KIYOSHI

Last Name

BROTKOWSKI

Business Name

EDDIE KIYOSHI BROTKOWSKI DDS

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

09/30/2012

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012