BRANDON WESLEY MECKELBERG DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****92

License Status

NOT RENEWED

Business

Title

DDS

First Name

BRANDON

Middle

WESLEY

Last Name

MECKELBERG

Business Name

BRANDON WESLEY MECKELBERG DDS

Original Issue Date

06/22/2017

Effective Date

06/22/2017

Expiration Date

09/30/2018

City

WAUTOMA

State

Zip

54982

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018