ALEXANDER GILLES BRODEUR Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****66

License Status

ACTIVE

Business

First Name

ALEXANDER

Middle

GILLES

Last Name

BRODEUR

Business Name

ALEXANDER GILLES BRODEUR

Original Issue Date

06/23/2016

Effective Date

07/02/2024

Expiration Date

09/30/2027

City

DUNLAP

State

Zip

61525

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/02/2024