DEREK R BERQUIST - Dentist License in Indiana | # 019030766

DEREK R BERQUIST

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019030766

License Status

NOT RENEWED

Business

N

First Name

DEREK

Middle

R

Last Name

BERQUIST

Business Name

DEREK R BERQUIST

Original Issue Date

06/24/2016

Effective Date

06/24/2016

Expiration Date

09/30/2018

State

IN

Ever Disciplined

N

LastModifiedDate

10/31/2018