DIANE R SAMSEL Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002065

License Status

NOT RENEWED

Business

First Name

DIANE R

Last Name

SAMSEL

Business Name

DIANE R SAMSEL

Original Issue Date

07/11/1973

Effective Date

06/12/2018

Expiration Date

01/31/2022

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/09/2022