JENNIFER ANN BLANK - Dentist License in Wisconsin | # 020011224

JENNIFER ANN BLANK

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011224

License Status

NOT RENEWED

Business

N

First Name

JENNIFER

Middle

ANN

Last Name

BLANK

Business Name

JENNIFER ANN BLANK

Original Issue Date

01/13/2005

Effective Date

09/30/2004

Expiration Date

09/30/2006

State

WI

Ever Disciplined

N

LastModifiedDate

11/08/2006