SUSAN J ELLENZ DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019019746

License Status

INACTIVE

Business

First Name

SUSAN J

Last Name

ELLENZ

Suffix

DDS

Business Name

SUSAN J ELLENZ DDS

Original Issue Date

08/07/1985

Effective Date

10/01/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

06/08/2015