TRACI L THEISSEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020012346

License Status

NOT RENEWED

Business

First Name

TRACI

Middle

Last Name

THEISSEN

Business Name

TRACI L THEISSEN

Original Issue Date

01/22/2008

Effective Date

11/05/2013

Expiration Date

09/30/2015

City

PONTOON BEACH

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

04/25/2016