AUTUMN MARIE SMITH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020012966

License Status

NOT RENEWED

Business

First Name

AUTUMN

Middle

MARIE

Last Name

SMITH

Business Name

AUTUMN MARIE SMITH

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

09/30/2012

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

11/14/2012