SUSAN M FANE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002845

License Status

NOT RENEWED

Business

First Name

SUSAN M

Last Name

FANE

Business Name

SUSAN M FANE

Original Issue Date

07/13/1976

Effective Date

08/08/2018

Expiration Date

01/31/2022

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/09/2022