GRANT CHRISTIAN BURGDORF DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****71

License Status

NOT RENEWED

Business

Title

DDS

First Name

GRANT

Middle

CHRISTIAN

Last Name

BURGDORF

Business Name

GRANT CHRISTIAN BURGDORF DDS

Original Issue Date

08/06/2015

Effective Date

08/06/2015

Expiration Date

09/30/2018

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018