GREGORY M DIETZ DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****70

License Status

ACTIVE

Business

First Name

GREGORY

Middle

Last Name

DIETZ

Suffix

DMD

Business Name

GREGORY M DIETZ DMD

Original Issue Date

06/08/2007

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024