DOMINIQUE ELENA DIETRICH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020015259

License Status

NOT RENEWED

Business

First Name

DOMINIQUE

Middle

ELENA

Last Name

DIETRICH

Business Name

DOMINIQUE ELENA DIETRICH

Original Issue Date

08/07/2015

Effective Date

09/25/2018

Expiration Date

01/31/2022

City

MACKINAW

State

Zip

61755

County

TAZEWELL

Ever Disciplined

LastModifiedDate

05/09/2022