HEIDI R FAGERSTROM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020007347

License Status

NOT RENEWED

Business

First Name

HEIDI R

Last Name

FAGERSTROM

Business Name

HEIDI R FAGERSTROM

Original Issue Date

02/01/1991

Effective Date

06/07/2018

Expiration Date

01/31/2022

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/09/2022