LOUIS VAN DER WA FOURIE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019009733

License Status

NOT RENEWED

Business

First Name

LOUIS VAN DER WA

Last Name

FOURIE

Business Name

LOUIS VAN DER WA FOURIE

Original Issue Date

08/18/1950

Effective Date

08/18/1950

Expiration Date

09/30/1990

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/12/2005