GAYLE D SHAFFER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****91

License Status

NOT RENEWED

Business

First Name

GAYLE D

Last Name

SHAFFER

Suffix

DMD

Business Name

GAYLE D SHAFFER DMD

Original Issue Date

06/08/1995

Effective Date

06/08/1995

Expiration Date

09/30/1998

City

FORREST

State

Zip

61741

County

LIVINGSTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005