DAVID ROBERT MORTENSEN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019016961

License Status

NOT RENEWED

Business

First Name

DAVID ROBERT

Last Name

MORTENSEN

Suffix

DMD

Business Name

DAVID ROBERT MORTENSEN DMD

Original Issue Date

09/28/1979

Effective Date

06/25/2012

Expiration Date

09/30/2015

City

WADSWORTH

State

Zip

60083

County

LAKE

Ever Disciplined

LastModifiedDate

02/08/2016