JOHN WILLIAM HULTQUIST DMD, MD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000180

License Status

NOT RENEWED

Business

Title

DMD, MD

First Name

JOHN

Middle

WILLIAM

Last Name

HULTQUIST

Business Name

JOHN WILLIAM HULTQUIST DMD, MD

Original Issue Date

09/21/2012

Effective Date

09/21/2012

Expiration Date

06/30/2015

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

01/07/2016