LARRY RAY MITTENDORF DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019012602

License Status

INACTIVE

Business

First Name

LARRY RAY

Last Name

MITTENDORF

Suffix

DDS

Business Name

LARRY RAY MITTENDORF DDS

Original Issue Date

07/14/1964

Effective Date

07/14/1964

Expiration Date

09/30/1990

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Ever Disciplined

LastModifiedDate

10/12/2005