EDWARD J DIESTELKAMP JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019011259

License Status

NOT RENEWED

Business

First Name

EDWARD J

Last Name

DIESTELKAMP JR

Suffix

DDS

Business Name

EDWARD J DIESTELKAMP JR DDS

Original Issue Date

08/08/1958

Effective Date

08/31/2012

Expiration Date

09/30/2015

City

GODFREY

State

Zip

62035

County

MADISON

Ever Disciplined

LastModifiedDate

02/08/2016