SUSAN J ELLENZ DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021001433

License Status

INACTIVE

Business

First Name

SUSAN J

Last Name

ELLENZ

Suffix

DDS

Business Name

SUSAN J ELLENZ DDS

Original Issue Date

08/01/1989

Effective Date

10/01/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Endodontics

Ever Disciplined

LastModifiedDate

06/08/2015