BRYAN M GOLDESBERRY 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

BRYAN

Middle

Last Name

GOLDESBERRY

Business Name

BRYAN M GOLDESBERRY

Original Issue Date

10/02/2008

Effective Date

08/03/2009

Expiration Date

09/30/2012

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012