HOLLY DEBLACK OMUNDSON - Dentist License in Illinois | # 020004411

HOLLY DEBLACK OMUNDSON

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020004411

License Status

NOT RENEWED

Business

N

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

State

IL

Ever Disciplined

N

LastModifiedDate

10/12/2005