GERARD BLAISE 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

GERARD

Last Name

BLAISE

Suffix

DDS

Business Name

GERARD BLAISE DDS

Original Issue Date

03/18/1985

Effective Date

09/26/2012

Expiration Date

09/30/2015

City

EAST SAINT LOUIS

State

Zip

62205

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016