MICHELE M FORTIN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002747

License Status

NOT RENEWED

Business

First Name

MICHELE M

Last Name

FORTIN

Business Name

MICHELE M FORTIN

Original Issue Date

12/03/1975

Effective Date

12/03/1975

Expiration Date

04/01/1982

City

LAKE VILLA

State

Zip

60046

County

LAKE

Ever Disciplined

LastModifiedDate

10/12/2005