BRIAN THOMAS FOSSE DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****03

License Status

CANCELLED

Business

First Name

BRIAN THOMAS

Last Name

FOSSE

Suffix

DDS

Business Name

BRIAN THOMAS FOSSE DDS

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

NORTH MUSKEGON

State

Zip

49445

County

MICHIGAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005