BRYAN RICHARD BLAZER DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

ACTIVE

Business

Title

DDS

First Name

BRYAN

Middle

RICHARD

Last Name

BLAZER

Business Name

BRYAN RICHARD BLAZER DDS

Original Issue Date

05/26/2016

Effective Date

07/01/2024

Expiration Date

09/30/2027

City

DE PERE

State

Zip

54115

County

BROWN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/01/2024