ANITA JAWQUIN BERGMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002178

License Status

NOT RENEWED

Business

First Name

ANITA JAWQUIN

Last Name

BERGMAN

Business Name

ANITA JAWQUIN BERGMAN

Original Issue Date

07/03/1974

Effective Date

07/03/1974

Expiration Date

09/30/1984

City

RANTOUL

State

Zip

61866

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

10/12/2005