NATHAN LONG DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

NOT RENEWED

Business

First Name

NATHAN

Last Name

LONG

Suffix

DDS

Business Name

NATHAN LONG DDS

Original Issue Date

01/01/1998

Effective Date

11/16/2009

Expiration Date

09/30/2012

City

CRETE

State

Zip

60417

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012