GAYLEN LEE JOHNSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****59

License Status

NOT RENEWED

Business

First Name

GAYLEN

Middle

LEE

Last Name

JOHNSON

Suffix

DDS

Business Name

GAYLEN LEE JOHNSON DDS

Original Issue Date

07/27/1998

Effective Date

07/24/2015

Expiration Date

09/30/2018

City

GALESBURG

State

Zip

61401

County

KNOX

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018