BRUCE JOHN DIETZ 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

BRUCE JOHN

Last Name

DIETZ

Suffix

DDS

Business Name

BRUCE JOHN DIETZ DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2004

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005