GREGORY DALE LONG DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****68

License Status

NOT RENEWED

Business

Title

DMD

First Name

GREGORY

Middle

DALE

Last Name

LONG

Business Name

GREGORY DALE LONG DMD

Original Issue Date

08/02/2017

Effective Date

08/02/2017

Expiration Date

09/30/2018

City

METAMORA

State

Zip

61548

County

WOODFORD

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018