GARY SCOTT NICKERSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

NOT RENEWED

Business

First Name

GARY SCOTT

Last Name

NICKERSON

Business Name

GARY SCOTT NICKERSON

Original Issue Date

01/17/1985

Effective Date

01/17/1985

Expiration Date

09/30/1996

City

GLENWOOD

State

Zip

60425

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005