KELLY J FERGUSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020010866

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

FERGUSON

Business Name

KELLY J FERGUSON

Original Issue Date

02/06/2004

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

DAVENPORT

State

Zip

52806

County

IOWA

Ever Disciplined

LastModifiedDate

05/09/2007