MICHAEL JAMES FOSSELMAN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021000900

License Status

NOT RENEWED

Business

First Name

MICHAEL JAMES

Last Name

FOSSELMAN

Suffix

DDS

Business Name

MICHAEL JAMES FOSSELMAN DDS

Original Issue Date

12/09/1976

Effective Date

09/21/2009

Expiration Date

09/30/2012

City

WASHINGTON

State

Zip

61571

County

TAZEWELL

Specialty/Qualifier

Orthodontics

Ever Disciplined

LastModifiedDate

11/14/2012