GARY L STAFFORD DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

NOT RENEWED

Business

First Name

GARY

Middle

Last Name

STAFFORD

Suffix

DMD

Business Name

GARY L STAFFORD DMD

Original Issue Date

05/23/1988

Effective Date

12/02/2009

Expiration Date

09/30/2012

City

MILWAUKEE

State

Zip

53233

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012