KETLEN KRISTIAN BYSTROM - Dentist License in Illinois | # 136000198

KETLEN KRISTIAN BYSTROM

Business Entity

EXPIRED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000198

License Status

EXPIRED

Business

N

First Name

KETLEN

Middle

KRISTIAN

Last Name

BYSTROM

Business Name

KETLEN KRISTIAN BYSTROM

Original Issue Date

01/29/2015

Effective Date

02/01/2015

Expiration Date

01/31/2018

State

IL

Ever Disciplined

N

LastModifiedDate

04/10/2018