TODD MICHAEL FATKIN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020013678

License Status

NOT RENEWED

Business

First Name

TODD

Middle

MICHAEL

Last Name

FATKIN

Business Name

TODD MICHAEL FATKIN

Original Issue Date

07/13/2011

Effective Date

08/05/2015

Expiration Date

09/30/2018

City

EAST GALESBURG

State

Zip

61430

County

KNOX

Ever Disciplined

LastModifiedDate

10/31/2018