GARY WAYNE GUSTAVSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****94

License Status

NOT RENEWED

Business

Title

DDS

First Name

GARY

Middle

WAYNE

Last Name

GUSTAVSON

Business Name

GARY WAYNE GUSTAVSON DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2004

City

SKOKIE

State

Zip

60077

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005