CHAD J VERSLUIS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

CHAD

Middle

Last Name

VERSLUIS

Business Name

CHAD J VERSLUIS

Original Issue Date

08/03/2006

Effective Date

08/03/2006

Expiration Date

09/30/2009

City

GENESEO

State

Zip

61254

County

HENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009