BRIAN WADE ANCELL Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

WADE

Last Name

ANCELL

Business Name

BRIAN WADE ANCELL

Original Issue Date

06/05/2014

Effective Date

08/06/2015

Expiration Date

09/30/2018

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/31/2018