LARRY WALLACE MIZELLE - Dentist License in Michigan | # 019020062

LARRY WALLACE MIZELLE

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019020062

License Status

NOT RENEWED

Business

N

First Name

LARRY WALLACE

Last Name

MIZELLE

Business Name

LARRY WALLACE MIZELLE

Original Issue Date

06/04/1986

Effective Date

06/04/1986

Expiration Date

09/30/2004

State

MI

Ever Disciplined

N

LastModifiedDate

10/17/2005