SID W BRANTLEY DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

SID W

Last Name

BRANTLEY

Suffix

DMD

Business Name

SID W BRANTLEY DMD

Original Issue Date

03/19/1991

Effective Date

03/19/1991

Expiration Date

09/30/1992

City

PADUCAH

State

Zip

42001

County

KENTUCKY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005