HOLLY DEBLACK OMUNDSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020004411

License Status

NOT RENEWED

Business

First Name

HOLLY DEBLACK

Last Name

OMUNDSON

Business Name

HOLLY DEBLACK OMUNDSON

Original Issue Date

12/09/1980

Effective Date

12/09/1980

Expiration Date

09/30/1988

City

AURORA

State

Zip

60505

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/12/2005