TIMOTHY A THEISEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019020619

License Status

NOT RENEWED

Business

First Name

TIMOTHY A

Last Name

THEISEN

Business Name

TIMOTHY A THEISEN

Original Issue Date

07/18/1987

Effective Date

06/15/2015

Expiration Date

09/30/2018

City

SARASOTA

State

Zip

34241

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/31/2018