BROCKTON R WILLEY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019030407

License Status

NOT RENEWED

Business

Title

DDS

First Name

BROCKTON

Middle

Last Name

WILLEY

Business Name

BROCKTON R WILLEY DDS

Original Issue Date

08/04/2015

Effective Date

08/27/2018

Expiration Date

01/31/2022

City

GRAND RAPIDS

State

Zip

49504

Ever Disciplined

LastModifiedDate

05/09/2022