DEREK PHILLIP GRZANICH DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

CANCELLED

Business

First Name

DEREK

Middle

PHILLIP

Last Name

GRZANICH

Suffix

DDS

Business Name

DEREK PHILLIP GRZANICH DDS

Original Issue Date

05/23/2005

Effective Date

06/15/2018

Expiration Date

12/31/2021

City

MISSOURI CITY

State

Zip

77459

County

TEXAS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/11/2021