AMY M VANFOSSEN DDS - Dentist License in Illinois | # 018001412

AMY M VANFOSSEN DDS

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001412

License Status

EXPIRED

Business

N

First Name

AMY

Middle

M

Last Name

VANFOSSEN

Suffix

DDS

Business Name

AMY M VANFOSSEN DDS

Original Issue Date

06/26/2003

Effective Date

06/26/2003

Expiration Date

06/30/2004

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005