BRENT J MARTIN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

NOT RENEWED

Business

First Name

BRENT J

Last Name

MARTIN

Suffix

DDS

Business Name

BRENT J MARTIN DDS

Original Issue Date

07/29/1997

Effective Date

07/29/1997

Expiration Date

09/30/2000

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005