DAWN M PROVENZANO Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020010305

License Status

ACTIVE

Business

First Name

DAWN

Middle

Last Name

PROVENZANO

Business Name

DAWN M PROVENZANO

Original Issue Date

06/13/2002

Effective Date

05/01/2024

Expiration Date

09/30/2027

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

06/27/2024