BLAKE ANTHONY FERANDO DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****76

License Status

NOT RENEWED

Business

Title

DMD

First Name

BLAKE

Middle

ANTHONY

Last Name

FERANDO

Business Name

BLAKE ANTHONY FERANDO DMD

Original Issue Date

06/07/2016

Effective Date

06/07/2016

Expiration Date

09/30/2018

City

GILLESPIE

State

Zip

62033

County

MACOUPIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/31/2018