KENNETH NEAL BROSH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

NOT RENEWED

Business

First Name

KENNETH

Middle

NEAL

Last Name

BROSH

Business Name

KENNETH NEAL BROSH

Original Issue Date

02/01/1990

Effective Date

02/01/1990

Expiration Date

09/30/1994

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005