License Number: DN15537

Data As Of 8/8/2020

Profession Dentist
License DN15537
License Status CLEAR/ACTIVE
License Expiration Date 2/28/2022
License Original Issue Date 02/05/2001
Address of Record 3331 W. BEARSS AVE
TAMPA, FL 33618
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain) No
Discipline on File No
Public Complaint No

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