LEIGH A BRANDENBURG Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

NOT RENEWED

Business

First Name

LEIGH

Middle

Last Name

BRANDENBURG

Business Name

LEIGH A BRANDENBURG

Original Issue Date

04/13/2015

Effective Date

04/13/2015

Expiration Date

09/30/2015

City

CEDARBURG

State

Zip

53012

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/08/2016