Martin Orville Gustafson Dds

License

Licensed by

Illinois Department of Financial and Professional Regulation

License number

019012622

Status

Revoked or denied (Refuse To Renew)

First issued

November 25, 1964

Expired

September 30, 2009

License holder

Martin Orville Gustafson Dds

Entity type

Individual

Classifications

• Licensed Dentist (Dental) Dental

More from the license record

Current term began

10/01/2006

Ever disciplined

Yes

Discipline case

2009006419

Discipline action

Refuse To Renew

Discipline reason

For Failure to Respond to A Continuing Education Audit.

Discipline dates

08/27/2009

Other Illinois licenses under this name

• IL
  Martin Orville Gustafson Dds

  License 021000659

  Licensed Specialist in Dentistry (Dental)
  Expired

  Geneva, IL

  Expired Sep 30, 2009
• IL
  Martin Orville Gustafson Dds

  License 137000151

  Dental Sedation Permit
  Revoked or denied

  Geneva, IL

  Expired Sep 30, 2009
• IL
  Martin Orville Gustafson Dds

  License 31*****45

  Licensed Dentist Controlled Substance (Dental)
  Expired

  Geneva, IL

  Expired Sep 30, 2009
• IL
  Martin Orville Gustafson Dds

  License 31*****44

  Licensed Dentist Controlled Substance (Dental)
  Expired

  Chicago, IL

  Expired Sep 30, 1984

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