SHANE MICHAEL VAN VLEET DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019027400

License Status

INACTIVE

Business

First Name

SHANE

Middle

MICHAEL

Last Name

VAN VLEET

Suffix

DMD

Business Name

SHANE MICHAEL VAN VLEET DMD

Original Issue Date

06/12/2007

Effective Date

09/22/2015

Expiration Date

09/30/2018

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Ever Disciplined

LastModifiedDate

09/22/2015