MARY ELLEN THIENEMANN Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020003547

License Status

INACTIVE

Business

First Name

MARY ELLEN

Last Name

THIENEMANN

Business Name

MARY ELLEN THIENEMANN

Original Issue Date

06/23/1978

Effective Date

06/23/1978

Expiration Date

09/30/2002

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/17/2005