LEANNE M FREDRICKSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000693

License Status

NOT RENEWED

Business

Title

DDS

First Name

LEANNE

Middle

Last Name

FREDRICKSON

Business Name

LEANNE M FREDRICKSON DDS

Original Issue Date

06/11/1993

Effective Date

06/11/1993

Expiration Date

06/30/1994

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005