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Licensed Professional Information:
Dentist 2901016473


 

Licensee Detail

 
SPECIALTY CERTIFICATION

Specialty Certification:

Oral and Maxillofacial Surgery

Status:

Active

Issue Date:

07/26/1999

Expiration Date:

06/21/2029

CONTROLLED SUBSTANCE LIST

City:

Novi

State or Province:

Michigan

ZIP or Postal Code:

48375

CS Record Number:

5315175837

CS Status:

Active

CS Expiration Date:

06/21/2029

DRUG CONTROL LIST

City:

Novi

State:

Michigan

ZIP Code:

48375

DC Record Number:

5307006357

DC Status:

Active

DC Expiration Date:

06/21/2029

 
 

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