BRENT ALLEN DANIELSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

NOT RENEWED

Business

First Name

BRENT ALLEN

Last Name

DANIELSON

Suffix

DDS

Business Name

BRENT ALLEN DANIELSON DDS

Original Issue Date

01/01/1998

Effective Date

09/27/2012

Expiration Date

09/30/2015

City

LAGRANGE

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016