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Credential/License Summary for 3863

Name: KOCH, BRIAN D
Profession: DENTISTRY (15)
Credential/License Number: 3863-15
Location: GREEN BAY WI
Credential/License Type: regular
Status: License is not current (Expired)
Eligible To Practice: Not Eligible to Practice

Details
Requirements
Payments
Orders
Relationships

Credential/License current through: 9/30/2023
Granted date: 9/15/1987
Multi-state: N
Orders: NONE
Specialties: Sedation I
Other Names: Brian D Koch

Requirement Code Complied? Complied Date
Renewal Requirements for the year: 2021
CPR requirement complied 09/13/2021
FEE requirement complied 09/13/2021
SIG requirement complied 09/13/2021
Renewal Year Amount Paid Payment Received
2021 60 09/13/2021

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ATTENTION: If a renewal application including payment is received by the renew by date (or Credential/License current through date), the credential holder is eligible to practice while the credential renewal is being processed. The credential holder must respond to any requests for information during the renewal process. See Wis. Stat. ยง 227.51(2).

Requirement Code Description

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