JENNA ROSE STORK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011050

License Status

NOT RENEWED

Business

First Name

JENNA

Middle

ROSE

Last Name

STORK

Business Name

JENNA ROSE STORK

Original Issue Date

06/30/2004

Effective Date

06/15/2009

Expiration Date

09/30/2012

City

PERU

State

Zip

61354

County

LA SALLE

Ever Disciplined

LastModifiedDate

11/14/2012