SHANNON MAE PALM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020013430

License Status

NOT RENEWED

Business

First Name

SHANNON

Middle

MAE

Last Name

PALM

Business Name

SHANNON MAE PALM

Original Issue Date

10/19/2010

Effective Date

08/17/2015

Expiration Date

09/30/2018

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/31/2018